Journal of Geriatric Cardiology · May 28, 2026

Frailty as a predictor of adverse in-hospital outcomes in older patients with Takotsubo cardiomyopathy

By Bahar AR, Bahar Y, Sirekulam V et al.

BACKGROUND: Takotsubo cardiomyopathy (TCM), defined by transient left ventricular dysfunction, is commonly triggered by acute emotional/physical stress. It is recognized as a cause of acute coronary syndrome, particularly in the elderly population, as they are vulnerable due to multiple comorbidities, including frailty, a condition marked by reduced functional reserve and increased susceptibility to stressors. METHODS: A retrospective analysis of the National Inpatient Sample (2016-2021) was performed to identify patients aged 65 and older hospitalized with TCM using ICD-10-CM codes. Patients were classified based on frailty, defined by Johns Hopkins ACG frailty-defining diagnoses. Multivariable mixed-effects logistic regression was used to identify independent predictors of in-hospital outcomes and compare the groups. Propensity score matching was applied to 736 pairs to control for confounders and assess outcomes. RESULTS: Frail patients had significantly high in-patient mortality (5.71 vs. 1.09%, P < 0.001), cardiogenic shock (8.47 vs. 4.70%, P = 0.003), sudden cardiac arrest (3.12 vs. 1.49%, P = 0.037), sepsis (2.85 vs. 0.95%, P = 0.008), and major adverse cardiac events (22.55 vs. 18.21%, P = 0.038). There was no significant difference in acute stroke, pulmonary embolism, mechanical circulatory support utilization, cardiac arrhythmias, acute kidney injury, pacemaker insertion, and length of stay between the two groups. CONCLUSION: Frailty is associated with an increased in-hospital mortality among elderly patients with TCM. Understanding the importance of frailty in elderly population with TCM helps us in optimizing management strategies and improving patient outcomes.

doi.org/10.26599/1671-5411.2026.05.004Open accessPubMed 42395844Biomarkers