Frailty as a predictor of adverse in-hospital outcomes in older patients with Takotsubo cardiomyopathyOA

Background Takotsubo cardiomyopathy(TCM),defined by transient left ventricular dysfunction,is commonly triggered by acute emotional/physical stress.It is recognized as a cause of acute coronary syndrome,particularly in the elderly population,as they are vulnerable due to multiple comorbidities,including frailty,a condition marked by reduced functional reserve and increased susceptibility to stressors.Methods A retrospective analysis of the National Inpatient Sample(2016-2021)was performed to identify patients aged 65 and older hospitalized with TCM using ICD-10-CM codes.Patients were classified based on frailty,defined by Johns Hopkins ACG frailty-defining diagnoses.Multivariable mixed-effects logistic regression was used to identify independent predictors of in-hospital outcomes and compare the groups.Propensity score matching was applied to 736 pairs to control for confounders and assess outcomes.Results Frail patients had significantly high in-patient mortality(5.71 vs.1.09%,P<0.001),cardiogenic shock(8.47 vs.4.70%,P=0.003),sudden cardiac arrest(3.12 vs.1.49%,P=0.037),sepsis(2.85 vs.0.95%,P=0.008),and major adverse cardiac events(22.55vs.18.21%,P=0.038).There was no significant difference in acute stroke,pulmonary embolism,mechanical circulatory support utilization,cardiac arrhythmias,acute kidney injury,pacemaker insertion,and length of stay between the two groups.Conclusion Frailty is associated with an increased in-hospital mortality among elderly patients with TCM.Understanding the importance of frailty in elderly population with TCM helps us in optimizing management strategies and improving patient outcomes.