Racial and Ethnic Disparities in In-Hospital Outcomes of Takotsubo Cardiomyopathy in the United States.

BACKGROUND

Racial disparities in outcomes among patients with Takotsubo cardiomyopathy (TCM) remain poorly characterized. While TCM is traditionally considered a reversible condition, emerging evidence suggests substantial variation in severity, complications, and resource utilization across racial groups.

OBJECTIVES

To evaluate racial and ethnic differences in the primary outcomes of in-hospital mortality and cardiogenic shock among adults hospitalized with TCM, and to assess secondary complications and resource utilization.

METHODS

We conducted a retrospective analysis of the National Inpatient Sample (2016–2022) that included adults hospitalized with TCM. Survey-weighted descriptive statistics were used to compare clinical characteristics across White, Black, Hispanic, and Asian populations. Primary outcomes were in-hospital mortality and cardiogenic shock. Survey-weighted multivariable logistic regression adjusted for demographic, clinical, and hospital characteristics estimated adjusted odds ratios (aOR) with 95% confidence intervals (CIs), using White patients as the reference group.

RESULTS

Among 289,545 weighted TCM hospitalizations, 77.3% were White, 8.2% Black, 6.3% Hispanic, and 2.1% Asian. Compared with White patients, Asian patients had higher adjusted odds of in-hospital mortality (aOR 1.47, 95% CI 1.22–1.77), cardiogenic shock (aOR 1.42, 95% CI 1.17–1.71), and invasive mechanical ventilation (aOR 2.18, 95% CI 1.42–3.35). Black patients had higher adjusted odds of acute kidney injury (aOR 1.40, 95% CI 1.30–1.52) and cardiac arrest (aOR 1.34, 95% CI 1.17–1.54). Hispanic patients had lower odds of atrial fibrillation (aOR 0.62, 95% CI 0.56–0.69) and ventricular arrhythmias (aOR 0.77, 95% CI 0.66–0.89). Length of stay and total hospital charges were significantly higher in Asian and Black patients.

CONCLUSIONS

Racial and ethnic differences were observed in the primary outcomes of in-hospital mortality and cardiogenic shock, with Asian patients demonstrating the highest adjusted odds of both. Asian and Black patients demonstrate disproportionate risks of hemodynamic instability, critical illness, and resource utilization. These findings underscore the importance of targeted clinical awareness and investigation into the biological, structural, and socioeconomic factors that contribute to inequities in TCM outcomes.