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Referral to Cardiac Rehabilitation and Outcomes for Patients With Takotsubo Cardiomyopathy

Wu, Carolyn M., MD, MS; McKeon, John, MS; Abbott, J. Dawn, MD; Jiang, Lan, MS; Wu, Wen-Chih, MD

Journal of Cardiopulmonary Rehabilitation and Prevention: May 2019 - Volume 39 - Issue 3 - p E8–E11
doi: 10.1097/HCR.0000000000000433
Brief Reports

Purpose: The aim of this study was to determine participation rates and outcomes for patients with Takotsubo cardiomyopathy (TC) in a cardiac rehabilitation (CR) program.

Methods: Patients at 2 academic medical centers with a discharge diagnosis of TC from January 2008 to March 2015 were retrospectively identified. Patients meeting the Mayo Clinic criteria for TC were cross-matched to the CR center affiliated with the hospitals to determine the referral rate and outcomes after completion of the program.

Results: In total, 380 unique patients were identified who survived the index hospitalization. Eighteen patients (5%) were referred to CR, 15 enrolled, and of those enrolled, 10 patients (67%) completed the program. Patients undergoing percutaneous coronary intervention of a nonculprit vessel at the time of diagnosis was the only predictor for referral to CR (11% vs 1%, P = .01). The 10 patients who completed CR attended 33 ± 6 (range, 20-36) sessions. Weight and body mass index reduction were 2.8 ± 3.5 lb and 0.6 ± 0.7 kg/m2 (P = .04, both), respectively. Post-CR exercise duration was 37 ± 4 min/session, which improved by 13 ± 6 min/session from baseline (P < .01). Two patients entered the phase III maintenance program. One-year cardiac readmission rates were comparable among patients who completed CR and those who were referred but did not attend or complete CR (0% vs 13%, P = .47).

Conclusions: Referral for the TC population was low; however, enrollment and completion rates were adequate, with percutaneous coronary intervention in nonculprit vessel as the only predictor of CR referral. Limited data showed CR may help with weight reduction and improve exercise duration.

The outcome of cardiac rehabilitation (CR) for patients with Takotsubo cardiomyopathy and referral rates were examined. Referral rate was low-only 18 of 380 (5%) patients were referred and 10 completed CR. Percutaneous coronary intervention was the only predictor for referral. Patients with CR completion showed significant weight reduction and improved exercise duration.

Division of Cardiology, School of Medicine, Georgetown University, MedStar Washington Hospital Center, Washington, District of Columbia (Dr C. M. Wu); Touro College of Osteopathic Medicine, New York City, New York (Mr McKeon); Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Drs Abbott and W.-C. Wu); Veterans Affairs Medical Center, Providence, Rhode Island (Ms Jiang and Dr W.-C. Wu); and Miriam Hospital Center for Cardiac Fitness, Providence, Rhode Island (Dr W.-C. Wu).

Correspondence: Wen-Chih Wu, MD, Division of Cardiology, Veterans Affairs Medical Center 830 Chalkstone Ave, Providence, RI 02908 (

The authors declare no conflicts of interest.

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