Key result
Anxiety increases HF hospital stays and costs, while depression is linked to ~14% lower mortality.
Why the study?
To evaluate how specific psychiatric comorbidities relate to index length of stay, hospital costs, and in-hospital mortality during readmissions after heart failure hospitalization.
How do specific psychiatric comorbidities affect length of stay, hospital costs, and mortality in adults hospitalized for heart failure?
Cohort (n=31,886,859)
Yes
How do specific psychiatric comorbidities affect length of stay, hospital costs, and mortality in adults hospitalized for heart failure?
In patients hospitalized for heart failure, anxiety is associated with increased hospital utilization and costs, whereas other psychiatric comorbidities like depression and bipolar disorder are paradoxically associated with lower in-hospital mortality during readmissions.
Answers are grounded in this paper and cite their sources.
Anxiety was associated with longer heart failure stays; hypothesis-generating for integrated psychiatric care before practice change.
Objective To evaluate how specific psychiatric comorbidities relate to index length of stay (LOS), hospital costs, and in-hospital mortality during readmissions after HF hospitalization. Methods A retrospective cohort study was conducted using the 2016-2022 Nationwide Readmissions Database. Adults with a principal HF diagnosis were included. Psychiatric comorbidities were depression, anxiety, bipolar disorder, schizophrenia/psychotic disorders, post-traumatic stress disorder (PTSD), and substance use disorder (SUD). Outcomes were index LOS, inflation-adjusted costs, and in-hospital mortality during readmissions within 30 days and up to 1 year after discharge. Survey-weighted multivariable models adjusted for demographics, socioeconomic factors, hospital characteristics, discharge disposition, and comorbidity burden; P ≤ 0.001 was prespecified as the level of statistical significance. Results Among 31,886,859 weighted HF hospitalizations, psychiatric comorbidity was common. Anxiety was associated with longer LOS (β = 0.88 days; P < 0.001) and higher costs (β = $2779; P < 0.001) but there were no differences in 30-day or 1-year mortality. However, several diagnoses were associated with lower mortality, including depression (30-day OR = 0.86; 1-year OR = 0.86), bipolar disorder (0.66; 0.68), schizophrenia/psychotic disorders (0.68; 0.72), PTSD (0.73; 0.78), and SUD (0.87; 0.92) (all P < 0.001). Bipolar disorder showed the largest cost reduction ( β = −$1320; P < 0.001) compared to HF patients without bipolar disorder. Conclusion Psychiatric comorbidity in HF is common. Anxiety is associated with increased hospital utilization, but is not associated with mortality, whereas several other diagnoses are associated with lower mortality. Costs were lower for depression and bipolar disorder. These diagnosis-specific patterns support targeted screening, early consultation, and integrated consultation-liaison care pathways during HF hospitalization.
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Charles et al. (2026) conducted a cohort in Heart Failure (n=31,886,859). Psychiatric comorbidities (depression, anxiety, bipolar disorder, schizophrenia, PTSD, SUD) vs. Heart failure patients without the specific psychiatric comorbidity was evaluated on Index length of stay, inflation-adjusted costs, and in-hospital mortality during readmissions within 30 days and up to 1 year after discharge (OR 0.86, p=<0.001). Anxiety increased length of stay and costs in heart failure patients, while depression and bipolar disorder were associated with lower mortality.
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