Results
From 2007-14, 43,92,471 hospitalizations with AIS were identified, of which, 2242 (0.4%) had TTS. An increasing trend in prevalence of TTS was seen from 2007 with the highest number of cases recorded in 2014 (n=1081). Higher proportion of AIS-TTS cohort consisted of elderly (.65) (69.8%), white (77.5%) females (82.2%).
AIS-TTS cohort showed higher prevalence of comorbidities including congestive heart failure (37.5% vs 14%; p<0.001), coronary atherosclerosis (32.2% vs 25.7%; p<0.001), previous myocardial infarction (10.4% vs 6.4%; p<0.001), valvular disease (14.1% vs 10%; p<0.001), alcohol abuse(6.5% vs 3.9%; p<0.001), deficiency anemias (20.2% vs 11.5%; p<0.001), rheumatoid arthritis/collagen vascular diseases (4.2% vs 2.4%; p<0.001, chronic pulmonary disease (20.8% vs 14.9%; p<0.001), coagulopathy(6.2% vs 4.8%; p<0.001), fluid and electrolytes disorders (37.4% vs 19.9%; p<0.001) and hypothyroidism (14.3% vs 12.5%; p<0.001) as compared to AIS patients without TTS.
All-cause in-hospital mortality in AIS patients with TTS was double than patients without TTS (10.2% vs 5.1%; p<0.001). Moreover, AIS hospitalizations were associated with higher odds of cardiogenic shock (OR 8.84, CI:4.07-19.17; p<0.001), cardiac arrest (OR 3.17, CI:1.57-6.42; p=0.001), respiratory failure (OR 3.13, CI:2.42-4.05; p<0.001), venous thromboembolism (OR 1.68, CI:1.14-2.47; p=0.008), and need for intubation/mechanical ventilation (OR 4.09, CI:3.14-5.32; p<0.001) among AIS patients with TTS.
Mean LOS was higher among AIS-TTS cohort as compared to non-TTS cohort (8.59±10.03 vs 5.22±6.24; p<0.001). AIS patients with TTS required chronic care and step down to the Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF) more frequently compared to non-TTS patients (53.8% vs 42.9%). In addition, mean hospital charges were higher among AIS-TTS cohort ($85,854 vs $37,924).