Nationwide Utilization, Cost, and Outcome of Temporary Mechanical Circulatory Support in Takotsubo Cardiomyopathy.

A subset of patients with Takotsubo Cardiomyopathy (TCM) develops hemodynamic instability requiring temporary mechanical circulatory support (tMCS). We examined the National Inpatient Sample (NIS), a large national registry of hospitalized patients in the United States, to identify temporal trends in the utilization of tMCS in TCM patients along with clinical outcomes and cost. All adult hospitalizations of TCM from the National Inpatient Sample Database between 2007 to 2015 using ICD-9-CM codes were identified. We compared baseline characteristics, co-morbidities, mortality, length of stay and hospitalization costs among TCM patients with and without the need for tMCS. Propensity score matching to mitigate the differences was used. SAS 9.4 software was used for statistical analysis. Of 44,842 TCM hospitalizations, 1,120 (2.5%) received tMCS. Table 1 summarizes the baseline characteristics of this study population. Intra-aortic balloon pump (IABP) (1049/1120, 94%) was the most commonly utilized followed by extracorporeal oxygenation (66/1120, 5.8%) and paracorporeal ventricular assist device (20/1120, 0.2%) without any temporal trend in utilization pattern during the study period. After propensity matching, patients requiring tMCS for TCM as primary diagnosis were significantly younger (64.1±12.2 vs 66.3 ±12.9, P<0.0001) and more likely to be male. In-hospital mortality (9.3 % vs. 8.4 %; P = 0.73) was indifferent between the groups. However, the cost incurred during hospitalization and length of stay were higher in patients who underwent tMCS. The use of tMCS in patients with TCM and hemodynamic instability resulted in significantly higher cost, and length of hospital stay without positive impact on survival. This may be secondary to higher utilization of IABP contributing to worsening dynamic left ventricular outflow obstruction, systemic studies are needed. [ABSTRACT FROM AUTHOR]