Racial and Ethnic Disparities in Clinical Outcomes among Patients with Takotsubo Syndrome; A Nation-Wide Analysis

Abstract

Background: Takotsubo syndrome or cardiomyopathy (TTS) is a transient left ventricular dysfunction often precipitated by stress, with unclear mechanisms ranging from coronary artery spasm to microvascular dysfunction. Its true incidence remains uncertain, estimated at 1 to 2% among suspected acute coronary syndrome cases. This condition can have a favorable prognosis but is associated with fatal complications. Evidence suggests that TTS disproportionately affects minority racial groups due to elevated stress levels, highlighting the need for healthcare equity. Aim: Our study focused on exploring racial and ethnic disparities in-hospital outcomes and clinical characteristics for patients diagnosed with TTS. Results: In our analysis of 32,785 TTS hospitalizations, racial and ethnic disparities were significant: 80.5% were White, 6.7% Black, and 5.8% Hispanic, with the remainder from other minorities. Black and Hispanic patients, averaging 63 years, were younger than the 67-year average, with most below the 50th percentile of income, the majority being Black patients (50%). Black patients experienced more extended hospital stays (mean 4.5 days, p < 0.001) compared to Whites (3.4 days, mean decrease 1.1 days, p = 0.002), and Native Americans had the longest stays (5.1 days, mean increase 1.75 days, p = 0.045). Asian patients faced the highest healthcare charges (mean $79,111, increase $23,542, p < 0.02). Blacks had the highest risk of Diastolic Heart failure with 5.3% of patients (OR 1.6, p = 0.03). Cardiogenic shock with 8.25% in Black patients (OR 1.34, p < 0.001) and 11% in Asians (OR 2, p < 0.001). Blacks had the highest risk of stroke (4.8%, OR 2.1, p = 0.003). Pulmonary embolism in Blacks was (OR 1.8, p-value <0.001). Disparities extended to inpatient mortality and cardiac arrest, with Asians and Blacks facing the highest risks (1.8% mortality in Asians, OR 1.97, p < 0.001; cardiac arrest in Blacks 3.9%, OR 2.3, p = 0.002) compared to Whites. Conclusion: Our findings reveal significant racial and ethnic disparities in TTS hospitalizations, with minority groups experiencing adverse outcomes and higher healthcare costs. These disparities underscore the need for targeted healthcare interventions and further research to understand and address the barriers to equitable care for TTS patients.