Association between depression and readmission of heart failure: A national representative database study.,Progress in Cardiovascular Diseases

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Association between depression and readmission of heart failure: A national representative database study.
Progress in Cardiovascular Diseases ( IF 5.6 ) Pub Date : 2020-03-26 , DOI: 10.1016/j.pcad.2020.03.014
Neelkumar Patel ₁ , Sandipan Chakraborty ₁ , Dhrubajyoti Bandyopadhyay ₂ , Birendra Amgai ₃ , Adrija Hajra ₄ , Varunsiri Atti ₅ , Avash Das ₆ , Raktim K Ghosh ₇ , Prakash C Deedwania ₈ , Wilbert S Aronow ₉ , Carl J Lavie ₁₀ , Marco R Di Tullio ₁₁ , Muthiah Vaduganathan ₁₂ , Gregg C Fonarow ₁₃

Affiliation

Interfaith Medical Center, Brooklyn, New York, USA.
Icahn School of Medicine at Mount Sinai/Mount Sinai St Luke's West, Manhattan, New York, USA.
Interfaith Medical Center, New York, USA.
Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Michigan State University, Lansing, MI, USA.
University of Texas Southwestern Medical Center, TX, USA.
Case Western Reserve University, Heart and Vascular Institute, MetroHealth Medical Center, Cleveland, OH, USA.
University of California, San Francisco (UCSF), San Francisco, CA, USA.
Westchester Medical Center and New York Medical College, New York, USA.
John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA.
Columbia University Medical Center, New York, USA.
Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA.
Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA.

Introduction

Depression is a recognized predictor of adverse outcomes in patients with heart failure (HF) and is associated with poor quality of life, functional limitation, increased morbidity and mortality, decreased adherence to treatment, and increased rehospitalization. To understand the impact of depression on HF readmission, we conducted a retrospective cohort study using the Nationwide Readmission Database (NRD) 2010–2014.

Methods

We identified all patients with the primary discharge diagnosis of HF by ICD-9-CM codes. The primary outcome of the study was to identify 30-day all-cause readmission and causes of readmission in patients with and without depression. Multivariate Cox regression analysis was used to estimate the adjusted hazard ratio for the primary and secondary outcomes.

Results

Among, 3,500,570 patients admitted with HF, 9.7% had concomitant depression. Patients with depression were more likely to be readmitted within 30 days (19.7% vs. 18.5%; P < 0.001). Concomitant depression was associated with higher risk of all-cause readmissions within 30 days and 90 days [P < 0.001] but was not associated with increased readmissions due to cardiovascular (CV) cause at 30 days and 90 days. The hazard of psychiatric causes of readmission was higher in patients with depression, both at 30 days [P < 0.001], and 90 days [P < 0.001]. Most of the readmissions were due to CV causes, with HF being the most common cause.

Conclusion

Among patients hospitalized with HF, the presence of depression is associated with increased all-cause readmission driven mainly by psychiatric causes but not CV-related readmission. Standard interventions targeted toward HF are unlikely to modify this portion of all-cause readmission.

中文翻译：

抑郁与心力衰竭再入之间的关联：国家代表性数据库研究。

介绍

抑郁是心力衰竭（HF）患者不良结局的公认预测指标，与生活质量差，功能受限，发病率和死亡率增加，对治疗的依从性下降以及重新住院增加有关。为了了解抑郁症对HF再入院的影响，我们使用2010-2014年全国再入院数据库（NRD）进行了一项回顾性队列研究。

方法

我们通过ICD-9-CM代码确定了所有初发HF诊断的患者。该研究的主要结果是确定患有和不患有抑郁症的患者30天全因再入院和再入院的原因。多变量Cox回归分析用于估计主要和次要结局的调整后风险比。

结果

在3,500,570名HF患者中，有9.7％伴有抑郁症。抑郁症患者更有可能在30天内再次入院（19.7％对18.5％； P <0.001）。伴随抑郁症与30天和90天之内全因再入院的风险较高相关[P <0.001]，但与30天和90天因心血管（CV）引起的再入院率增加无关。抑郁症患者的精神病学再入院的危险性更高，分别在30天[P <0.001]和90天[P <0.001]时出现。再次入院的大多数是由于CV原因引起的，HF是最常见的原因。