Seasonal variation in patient characteristics and in-hospital outcomes of Takotsubo syndrome: a nationwide retrospective cohort study in Japan
- 253 Downloads
Although there is reportedly seasonal variation in the occurrence of Takotsubo syndrome (TTS), it is unknown whether there is a relationship between season and patient characteristics, or whether season influences outcomes. Using the Diagnosis Procedure Combination database in Japan, we retrospectively identified 4306 patients (mean age 73.6 years) hospitalized with TTS between January 2011 and December 2013. We divided patients into four groups according to season of admission [n = 914, Spring (March–May); n = 1243, Summer (June–August); n = 1245, Autumn (September–November); n = 904, Winter (December–February)]. The outcomes were in-hospital mortality and cardiovascular complications. We compared patient backgrounds and outcomes across seasons and estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for outcomes in logistic regression analyses adjusted for multiple propensity scores. Although there was no significant difference in age across seasons, the proportion of males differed significantly (from 18.5% in autumn to 23.9% in winter; p = 0.016). The incidence of psychiatric disease (from 4.9% in spring to 7.9% in summer; p = 0.025) and sepsis (from 0.8% in winter to 2.6% in summer; p = 0.019) also differed significantly with season. In-hospital mortality was not significantly influenced by season (p = 0.377): spring, 5.1%; summer, 6.0%; autumn, 4.6%; winter, 6.0%. However, in-hospital mortality ranged widely across months from 3.0% in September to 7.5% in April. The incidence of ventricular tachycardia/fibrillation was significantly different (p = 0.038): spring, 2.2% (reference); summer, 3.3% (aOR 1.46, 95% CI 0.84–2.51); autumn, 2.7% (aOR 1.27, 95% CI 0.72–2.22); winter, 4.4% (aOR 1.92, 95% CI 1.11–3.33). Although season did not appear to influence the in-hospital mortality of TTS, monthly variation may exist in the risk of death in patients with TTS. There were significant seasonal variations in the proportions of males, patients with psychiatric disease or sepsis, and the incidence of ventricular arrhythmias among patients with TTS.
KeywordsTakotsubo syndrome Season Background Mortality Complication
Compliance with ethical standards
This study was supported by grants from the Ministry of Health, Labour and Welfare, Japan (Grant numbers: H29-Policy-Designated-009 and H27-Policy-Strategy-011); the Ministry of Education, Culture, Sports, Science and Technology, Japan (Grant number: 17H04141); and the Japan Agency for Medical Research and Development. The funders had no role in the execution of this study or interpretation of the results.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the Institutional Review Board at The University of Tokyo.
The need for informed consent for each patient was waived because all data were anonymized.
- 2.Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, Sheppard MN, Figtree GA, Parodi G, Akashi YJ, Ruschitzka F, Filippatos G, Mebazaa A, Omerovic E (2016) Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 18:8–27CrossRefPubMedGoogle Scholar
- 3.Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015) Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 373:929–938CrossRefPubMedGoogle Scholar
- 17.Rumana N, Kita Y, Turin TC, Murakami Y, Sugihara H, Morita Y, Tomioka N, Okayama A, Nakamura Y, Ueshima H (2008) Seasonal pattern of incidence and case fatality of acute myocardial infarction in a Japanese population (from the Takashima AMI Registry, 1988 to 2003). Am J Cardiol 102:1307–1311CrossRefPubMedGoogle Scholar
- 19.Spreeuwenberg MD, Bartak A, Croon MA, Hagenaars JA, Busschbach JJ, Andrea H, Twisk J, Stijnen T (2010) The multiple propensity score as control for bias in the comparison of more than two treatment arms: an introduction from a case study in mental health. Med Care 48:166–174CrossRefPubMedGoogle Scholar
- 20.Murakami T, Yoshikawa T, Maekawa Y, Ueda T, Isogai T, Konishi Y, Sakata K, Nagao K, Yamamoto T, Takayama M, Network Scientific Committee CCU (2014) Characterization of predictors of in-hospital cardiac complications of Takotsubo cardiomyopathy: multi-center registry from Tokyo CCU Network. J Cardiol 63:269–273CrossRefPubMedGoogle Scholar
- 27.Nishida J, Kouzu H, Hashimoto A, Fujito T, Kawamukai M, Mochizuki A, Muranaka A, Kokubu N, Shimoshige S, Yuda S, Hase M, Tsuchihashi K, Miura T (2015) “Ballooning” patterns in Takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study. Heart Vessels 30:789–797CrossRefPubMedGoogle Scholar