Severe mental illness and mortality of hospitalized ACS patients in the VHA

Abstract

Background: Severe mental illness (SMI) has been associated with more medical co-morbidity and less cardiovascular procedure use for older patients with myocardial infarction. However, it is unknown whether SMI is associated with increased long term mortality risk among patients presenting with acute coronary syndromes (ACS). We tested the hypothesis that SMI is associated with higher one-year mortality following ACS hospitalization.

Preexisting Comorbid Psychiatric Conditions and Mortality in Nonsurgical Intensive Care Patients

“…Finally, prior publications 32 indicate that depression increases the risk of delirium Our findings of the risk of 30-day mortality associated with a comorbid psychiatric condition are consistent with the results of studies in veterans hospitalized for AMI by Plomondon et al 1 and Peterson et al, 3 who did not find an increased risk of 30-day mortality among patients with a comorbid psychiatric condition. In contrast to these prior studies, we found a modest association of preexisting comorbid psychiatric conditions with in-hospital mortality, although our study was powered to detect small differences in mortality between patients with and without comorbid psychiatric conditions relative to these prior studies.…”

“…We then excluded 18 057 patients without any VHA outpatient C omorbid psychiatric conditions are common among patients admitted to acute care hospitals. [1][2][3][4][5][6][7] Estimates of the impact of such comorbid conditions on hospital outcomes, however, are less clear. Although results of some studies 4,[8][9][10][11][12] indicate that patients with comorbid psychiatric conditions are subject to higher mortality and less likely to receive guideline-recommended care after admission for acute myocardial infarction (AMI), other studies 1,3,7 have not shown such disparities.…”

“…The inpatient files were used to identify 97 240 consecutive patients who were admitted to a VHA ICU from fiscal years 2004 to 2006 (October 1,2003 to September 30, 2006) with a nonsurgical diagnosisrelated group. We excluded 12 511 identified records that represented repeat ICU admissions.…”

“…Most of this work has been focused on patients who have had an AMI. [1][2][3][4][9][10][11][12] The purpose of this article is to address the lack of work examining the effects of existing psychiatric conditions across a broad spectrum of admissions to medical ICUs. We examined a national sample of patients admitted to ICUs in the Veterans Health Administration (VHA) hospitals, capitalizing on the VHA's rich infrastructure of administrative and clinical data.…”

Psychiatric Comorbidity and Mortality After Acute Myocardial Infarction

“…14 -18 However, other studies have failed to detect such relationships. 19,20 One potential explanation for the inconsistencies in the associations between AMI-related hospital outcomes and psychiatric comorbidities may be the methodological approach that has been used to identify psychiatric comorbidity from administrative databases. Therefore, we completed this study to directly evaluate how different approaches of identifying psychiatric comorbidities may impact AMI-related hospital outcomes for a range of psychiatric conditions.…”