A comorbid mental illness diagnosis in older patients hospitalized with heart failure was associated with higher 1-year mortality (OR 1.20; 95% CI 1.12-1.28) and 1-year readmission.
Cohort (n=53,314)
Sí
Does a comorbid mental illness diagnosis worsen quality of care and clinical outcomes in older patients hospitalized with heart failure?
Older heart failure patients with comorbid mental illness receive poorer quality of care (lower LVEF evaluation rates) and have higher risks of 1-year mortality and readmission.
Estimación del efecto: OR 1.20 (95% CI 1.12-1.28)
Tasa de eventos absoluta: 41% vs 36.2%
valor p: p=<.001
OBJECTIVE: To evaluate the effect of a mental illness diagnosis on quality of care and outcomes among patients with heart failure. DESIGN: Retrospective, national, population-based sample of patients with heart failure hospitalized from April 1, 1998, through March 31, 1999, and July 1, 2000, through June 30, 2001. SETTING: Nonfederal US acute care hospitals. PATIENTS: A total of 53 314 Medicare beneficiaries. MAIN OUTCOME MEASURES: Quality of care measures, including left ventricular ejection fraction (LVEF) assessment, prescription of an angiotensin-converting enzyme (ACE) inhibitor at discharge among patients without treatment contraindications, and 1-year readmission and 1-year mortality. RESULTS: Of the patients included in the study, 17.0% had a mental illness diagnosis. Compared with patients without mental illness diagnoses, eligible patients with mental illness diagnoses had lower rates of LVEF evaluation (53.0% vs 47.3%; P < .001) but comparable rates of ACE inhibitor prescription (71.3% vs 69.7%; P = .40). Findings were unchanged after multivariate adjustment: patients with mental illness had lower odds of LVEF evaluation (odds ratio OR, 0.81; 95% confidence interval CI, 0.76-0.87) but comparable rates of ACE inhibitor prescription (0.96; 0.80-1.14). Patients with mental illness diagnoses had higher crude rates of 1-year all-cause readmission (73.7% vs 68.5%; P < .001), which persisted after multivariate adjustment (OR, 1.30; 95% CI, 1.21-1.39). Crude 1-year mortality was higher among patients with a mental illness diagnosis (41.0% vs 36.2%; P < .001). Presence of a comorbid mental illness diagnosis was associated with 1-year mortality after multivariate adjustment (OR, 1.20; 95% CI, 1.12-1.28). CONCLUSIONS: Mental illness is commonly diagnosed among elderly patients hospitalized with heart failure. This subgroup receives somewhat poorer care during hospitalization and has a greater risk of death and readmission to the hospital.
Rathore et al. (Mon,) conducted a cohort in heart failure (n=53,314). Mental illness diagnosis vs. No mental illness diagnosis was evaluated on 1-year mortality (OR 1.20, 95% CI 1.12-1.28, p=<.001). A comorbid mental illness diagnosis in older patients hospitalized with heart failure was associated with higher 1-year mortality (OR 1.20; 95% CI 1.12-1.28) and 1-year readmission.
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