Abstract 10550: Mental Health Disorders and Readmissions Following Acute Myocardial Infarction

Abstract

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.

Mental Health Is Heart Health: Adjusting Clinical Guidelines for Depression After Myocardial Infarction

“…While the prevention of medical complications undoubtedly demands clinical attention, so do the potential psychiatric complications associated with cardiovascular disease (CVD). Depression and anxiety in patients post-MI are consistently associated with adverse health outcomes 5–10 . Nevertheless, in the midst of managing complicated and multifaceted care post-MI, clinicians often overlook mental health concerns due to time constraints and lack of knowledge, leaving patients untreated and at risk 11 …”

“…It was later found that patients with MI have an additional 50% increased risk of stroke if they experience depression 6 . Mental health disorders, including MDD, are also associated with a higher risk of 30-day readmission after MI and a 1.6% increase in adverse cardiovascular events 7,8 . Post-MI depression is associated with sedentary lifestyles and treatment nonadherence as well 9,10 …”

“…Depression and anxiety in patients post-MI are consistently associated with adverse health outcomes. [5][6][7][8][9][10] Nevertheless, in the midst of managing complicated and multifaceted care post-MI, clinicians often overlook mental health concerns due to time constraints and lack of knowledge, leaving patients untreated and at risk. 11 Major depressive disorder (MDD) is a leading cause of disability in the United States (US).…”