Takotsubo Cardiomyopathy After Subarachnoid Hemorrhage: Who Is At Risk?

Abstract

Introduction: Takotsubo Cardiomyopathy (TCM) is a rare but well recognized complication of subarachnoid hemorrhage associated with increased morbidity and poor clinical outcomes. There is a scarcity of literature describing the prevalence and risk factors associated with this complication. The aim of this study was to identify patients who are at risk of developing TCM in non-traumatic subarachnoid hemorrhage.

Methods: The 2016 to 2021 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of non-traumatic subarachnoid hemorrhage. Univariate and multivariable analyses adjusting for patient demographics, comorbidity status, and hemorrhage etiology were used to characterize statistical associations with disease-related complications. Patients with TCM were further divided into those with "good" or "poor" functional outcomes and compared.

Results: A total of 42 141 patients were identified as having a subarachnoid hemorrhage from 2016 to 2021. Of these patients 486 patients (1.2%) were found to have TCM. TCM was associated with increased length of stay (19.15 ± 17.8 days vs 11.72 ± 14.4, P < .001), increased total costs ($451 502.59 ± 443 777.9 vs $242 327.92 ± 338 862.3, P < .001), increased number of days from admission to first procedure (1.74 ± 4.5 vs 1.94 ± 5.0, P < .001), and increased mortality (31.7% vs 22.8%, P < .001). After controlling for confounding factors, independent risk factors for TCM in patients with non-traumatic subarachnoid hemorrhage included: Female (Odds Ratio [OR]: 3.11, 95% Confidence Interval [CI]: 2.50-3.89, P < .001), Congestive Heart Failure (OR:4.60, CI:3.70-5.71, P < .001), and Fluid and Electrolyte Disorders (OR: 2.52, CI: 2.05-3.11, P < .001). Patients with good functional outcomes were found to have younger age (54.85 years ± 14.0 vs 58.14 ± 14.7, P < .001), decreased length of stay (17.11 ± 16.9 vs 19.83 ± 18.1, P < .001), decreased total charge ($370 245.94 ± 517 702.8 vs $477 366.55 ± 417 122.4, P < .001), and decreased mortality (P < .001) compared to those with poor functional outcomes.

Conclusion: TCM after subarachnoid hemorrhage is associated with increased mortality, length of stay, total cost, number of procedures in patients, and number of days to first procedure. Neurosurgeons and Neurocritical care medical professionals should be aware of the comorbidities and factors associated with increased TCM after subarachnoid hemorrhage in order to improve patient outcomes.