Impact of socioeconomic status on one-year morbidity and readmission in patients with Takotsubo Syndrome: A Danish cohort study

Introduction: Takotsubo Syndrome (TS) is a cardiac condition that mimics myocardial infarction (MI). Long-term readmission data remain limited. Previous studies in other conditions suggest that socioeconomic factors, such as low income and unemployment, may influence readmission rates, but this has not been explored in TS. This study aims to investigate the risk factors of one-year readmissions in TS patients and the impact of socioeconomic factors, comparing results with matched individuals from the general population and those with MI. Methods A nationwide cohort study was conducted using national registers. Patients discharged alive from Danish hospitals with an incident TS diagnosis between 2008 and 2018 were identified through the Danish National Patient Registry. Each TS patient was matched with four individuals from the general population and patients with MI by sex and age. In the analyses of one-year readmission of TS, we included socioeconomic factors such as cohabitation, labor market attachment, education, family income psychological distress, and comorbidities. Results A total of 1022 individuals with TS were identified, with a median age of 70 years (IQR 61-77), and 89% were women. Compared to the general population, TS patients had higher rates of cardiovascular comorbidities, respiratory diseases, and psychotropic medication use, but fewer cardiac conditions except for heart failure in the MI population. TS patients were more likely to receive incapacity pensions, have basic education, and belong to the lowest income percentile compared to the general population. In the first year, (36%) of TS patients were readmitted, compared to 4% in the general population and 44% in the MI group. The most common causes of readmission in the TS cohort were cardiac (27%), ‘other’ conditions (22%), and respiratory (20%).Readmission rates were higher among TS patients in vulnerable socioeconomic groups compared to the general population: 37% vs 6% for those in the lowest income percentile, 42% vs 6 % for those with basic education, and 37% vs 4% for those on incapacity pension, but overall lower compared to the MI population. Most readmissions occurred within the first two months. The two lowest income quintiles, vocational/high school and below and living alone all predicted readmission. The lowest income had a Hazard Ratio of 1.64 and 95% confidence intervals of 1.01-2.69. Conclusion Although TS patients exhibit a disadvantaged socioeconomic profile and a substantial comorbidity burden, our analyses suggest that socioeconomic factors are associated with readmission risk, with part of this association potentially mediated through comorbidity burden. These findings indicate that, even in healthcare systems with free access such as Denmark’s, socioeconomic inequalities may remain relevant for readmission risk in TS patients.