Association of Social and Geographic Vulnerability With In-Hospital Outcomes in Takotsubo Cardiomyopathy: Insights From a National Database

Background Takotsubo cardiomyopathy (TTC) is a transient, acute cardiac dysfunction syndrome triggered by emotional or physical stress. The pathophysiology involves catecholamine excess and microvascular dysfunction. The influence of geographic access to care and socioeconomic context on clinical outcomes remains poorly characterized. This study tested whether rural hospital setting and low community income level independently associate with adverse in-hospital outcomes among patients hospitalized with TTC. Methodology We conducted a retrospective cohort study using the 2022 National Inpatient Sample. Adult hospitalizations with a principal diagnosis of TTC were identified using International Classification of Diseases, Tenth Revision, Clinical Modification coding. Hospitalizations were stratified by hospital location and teaching status and by median community income quartile. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, acute respiratory failure, arrhythmia, invasive mechanical ventilation, length of stay, total hospital charges, and discharge disposition. Multivariable logistic regression was performed using STATA survey procedures to account for the complex survey design. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results A total of 4,738 hospitalizations met the inclusion criteria. This represented a weighted national estimate of 23,690 admissions. Rural hospitals accounted for 1,017 admissions or 21.5%. Patients from the lowest income quartile (Q1) accounted for 1,486 admissions or 31.4%. Rural hospitalizations showed higher crude in-hospital mortality compared with urban hospitalizations at 4.7% versus 2.8%, with a p-value less than 0.001. Patients from Q1 had higher mortality than those from the highest income quartile (Q4) at 4.3% versus 2.5%, with a p-value equal to 0.002. After multivariable adjustment using survey-weighted logistic regression, rural hospitalization remained independently associated with in-hospital mortality with an aOR of 1.58, 95% CI of 1.16 to 2.15, and p-value of 0.004. Low income status also remained independently associated with mortality, with an aOR of 1.41, 95% CI of 1.03 to 1.94, and p-value of 0.031. Conclusions In this nationally representative sample of patients hospitalized with TTC, rural hospital location and low socioeconomic status were independently associated with increased in-hospital mortality. These findings suggest that structural factors, including geographic access to specialized cardiovascular services and community-level economic resources, influence clinical outcomes in this condition.