Association of cardiovascular metabolic risk factor measurements with psychiatric readmission among in-hospital patients with severe mental illness: a retrospective study

Abstract

Background Patients with severe mental illness (SMI) and comorbid physical conditions were often associated with higher risks of mortality and hospital readmission. In this study, we aim to examine the association of cardiovascular metabolic risk factor measurements with risks of psychiatric readmissions among in-hospital patients with severe mental illness (SMI). Methods We collected the longitudinal information of laboratory investigations, blood pressure and body mass index (BMI) among in-hospital patients who had been diagnosed with schizophrenia, major depression disorder or bipolar disorder and with comorbid diagnosis of hypertension, hyperlipidemia or diabetes from Jan 2014 to Jan 2019. The primary outcome was time to first psychiatric readmission. Cox proportional hazard model was utilized to calculate the hazard risks (HR) of cardiovascular metabolic risk factors with psychiatric readmission. Results A total of 5,256 patients were included in the analysis. Compared to patients with normal blood parameters, patients with aberrant tests of high-density dyslipidemia (HDL) and diastolic blood pressure (DBP) during in-hospitalization period were associated with higher risks to first psychiatric readmission [ HR (Hazard Ratio), 1.37 95% Confidence interval (CI), 1.03–1.83 for HDL and HR, 1.32 (95% CI, 1.04–1.67])for DBP]. Compared to patients with optimal monitoring, patients with suboptimal monitoring of blood lipids and blood pressure during in-hospitalization period or recommended window period of cardiovascular disease (CVD) risk management were associated with higher risks to first psychiatric readmission. Conclusions Aberrant cardiovascular metabolic blood test and blood pressure and missing measurements among in-hospital patients with SMI were associated with increased risks of psychiatric readmissions. This calls for more active screening and monitoring of CVD risk factors for those in-hospital patients in need.

Metabolic disturbances are risk factors for readmission to psychiatric hospitals in non-smokers but not in smokers: results from a Swiss psychiatric cohort and in first-episode psychosis patients

“…Considering associations between hypertriglyceridemia, central obesity, hyperglycemia, and readmission, it was not surprising to find an increased risk of readmission in non-smoking patients with metabolic syndrome. Thus, inpatients with severe mental illness whose metabolic risk factors were poorly monitored had an increased risk of readmission ( 62 ).…”

“…These findings should be carefully evaluated due to the small sample size. A recent study found a substantial link between dyslipidemia and acute-phase schizophrenia (61). Thus, more mechanistic studies are needed to better understand the relationship between HDL hypocholesterolemia and readmission in psychiatry.…”

A file audit of gym usage in an Australian private inpatient psychiatric hospital

“… 17 With higher rates of metabolic syndrome among mood disorders, psychiatric facilities require systemic integration of metabolic and cardiovascular assessment during admission. 18 Evidence from psychiatric readmission rates has shown that poor assessment and monitoring of metabolic risk factors of inpatients increases the likelihood of readmission 19 , 20 within a 28-day period. 21 While evidence is clear that exercise is beneficial in reducing symptomology in depression, anxiety disorders, bipolar disorder, and schizophrenia, 22 the lack of consistent and well-documented metabolic and cardiovascular assessment may reflect missed opportunities to improve treatment outcomes.…”

“… 21 While evidence is clear that exercise is beneficial in reducing symptomology in depression, anxiety disorders, bipolar disorder, and schizophrenia, 22 the lack of consistent and well-documented metabolic and cardiovascular assessment may reflect missed opportunities to improve treatment outcomes. 20 The lack of accessible documentation in the hospital file of activity patterns and markers or metabolic health prior to admission, on discharge and post discharge renders it impossible to determine if exercise was beneficial for those that accessed services in hospital.…”

Cardiac Dysfunction in People with Schizophrenia: Linking Clinical Outcome, the Heart, and the Brain

“…CVD includes arrhythmia, cardiomyopathy, coronary artery disease, heart attack, heart failure, and stroke (Everson-Rose & Lewis, 2005). It has been established that people with schizophrenia receive less equitable access to care compared to the general population (Crawford et al, 2014;Kisely et al, 2007;Mitchell & Lord, 2010;Osborn et al, 2011), where this suboptimal care often results in increased risk for psychiatric readmissions where CVD risk factors have not been adequately monitored (Tan et al, 2022). Tan and colleagues (2022) found that psychiatric readmissions were 37% more likely for people with poor follow-up care for blood lipid levels and 32% more likely for people with poor follow-up care for hypertension.…”