Introduction:
Hospital readmissions following an acute myocardial infarction (AMI) are associated with increased mortality and morbidity. The association of mental health disorders (MHD) and risk of readmission following AMI is not well studied.
Hypothesis:
We hypothesized that among patients with AMI, a co-morbid diagnosis of MHD is associated with increased risk of readmission.
Methods:
We analyzed the National Readmission Database for all adult AMI hospitalizations from 2016 to 2017. Co-morbid diagnoses of major depression, bipolar disorders, anxiety disorder and schizophrenia/other psychotic disorders were obtained using appropriate ICD-10 CM diagnostic codes. The primary outcome was 30-day all-cause unplanned readmission. A Cox-regression analysis was used to identify the association of MHD and risk of 30-day readmission adjusted for demographics, medical and cardiac comorbidities, and coronary revascularization.
Results:
We identified a total of 10,45,752 hospitalizations for AMI with a mean age of 66.6±12.9 years with 37.6% being females. The prevalence of any MHD was 15.0±0.9%. Readmission rates after AMI were higher for those with MHD compared to those without (
Figure
). After adjusting for potential confounders, comorbid diagnosis of major depression [rate 12.2%±0.5%, hazard ratio (HR) 1.11 (95% CI 1.07-1.15), p<0.001], bipolar disorders (rate 13.6±0.5%, HR 1.32 (1.19-1.45), p<0.001), anxiety disorders (rate 10.9±0.4%, HR 1.09 (1.05-1.13), p<0.001) and schizophrenia/other psychotic disorders (rate 17.5±0.6%, HR 1.56 (1.43-1.69), p<0.001) were independently associated with a higher risk of 30-day readmission compared to those with no comorbid MHD.
Conclusions:
Major depression, bipolar disorders, anxiety disorders and schizophrenia/other psychotic disorders are significantly associated with a higher independent risk of 30-day all-cause hospital readmissions among AMI hospitalizations in the United States.
Introduction: Intensive Care Units (ICUs) are among the most expensive components of hospital care. Experts believe that ICUs are overused; however, hospitals vary in their ICU admission rate. Our hypothesis is based on clinical observations that many patients with diabetic ketoacidosis (DKA), stroke, and gastrointestinal (GI) bleeding admitted to the ICU don’t really need it and could be managed safely in a non-ICU level of care. Reducing inappropriate admissions would reduce healthcare costs and improve outcomes. Our primary objective was to determine the frequency of inappropriate ICU admissions. Secondary objectives were to evaluate which diagnoses were more unnecessarily admitted to the ICU, evaluate different variables and comorbidities, and determine the mortality rates during ICU admissions.
Methods: Patients admitted to the ICU, from the Emergency Department (ED) or transferred from the floor, during a one-year period were evaluated in this retrospective study. Patients 18-years old and above who had an admitting diagnosis of DKA, GI bleed, ischemic stroke, or hemorrhagic stroke were included. Patients in a comatose state, intubated, on vasopressors, hemodynamically unstable or had an unstable comorbid disease, subarachnoid hemorrhage, surgery during hospitalization prior to the ICU admission were excluded. Patients were categorized as having an appropriate or inappropriate ICU admission based on our institutional ICU admission criteria and data from available literature and guidelines.
Results: A total of 95 patients were included in our cohort. Seventy-two out of 95 (76%) were considered as inappropriate ICU admissions. When comparing each of the four admitting diagnoses, a significantly higher proportion of DKA patients were considered inappropriate ICU admissions when compared to the other diagnoses (
P
= 0.001). The overall mortality rate of ICU admissions was 16%, 15 patients out of 95 study population. When comparing each of the four admitting diagnoses, there was a significant difference in mortality rate with DKA having the lowest mortality (3%) and GI bleed having the highest mortality (43%). Out of the 15 patients who died, only 1 patient was categorized as an inappropriate ICU admission.
Conclusions: More than three-quarters of our study population was admitted to the ICU inappropriately. Incorporating severity scores in ICU admission criteria could improve the appropriateness of ICU admission and financial feasibility.
This article is based on a poster: Alsamman S, Alsamman MA, Castro M, Koselka H, Steinbrunner J: ICU admission patterns in patients with DKA, stroke and GI bleed: do they all need ICU? J Hosp Med. March 2015.
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