Mental Disorders, Quality of Care, and Outcomes Among Older Patients Hospitalized With Heart Failure An Analysis of the National Heart Failure Project

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Rm IE-61 Sterling Hall of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA.
Archives of general psychiatry (Impact Factor: 14.48). 01/2009; 65(12):1402-8. DOI: 10.1001/archpsyc.65.12.1402
Source: PubMed


To evaluate the effect of a mental illness diagnosis on quality of care and outcomes among patients with heart failure.
Retrospective, national, population-based sample of patients with heart failure hospitalized from April 1, 1998, through March 31, 1999, and July 1, 2000, through June 30, 2001.
Nonfederal US acute care hospitals.
A total of 53 314 Medicare beneficiaries.
Quality of care measures, including left ventricular ejection fraction (LVEF) assessment, prescription of an angiotensin-converting enzyme (ACE) inhibitor at discharge among patients without treatment contraindications, and 1-year readmission and 1-year mortality.
Of the patients included in the study, 17.0% had a mental illness diagnosis. Compared with patients without mental illness diagnoses, eligible patients with mental illness diagnoses had lower rates of LVEF evaluation (53.0% vs 47.3%; P < .001) but comparable rates of ACE inhibitor prescription (71.3% vs 69.7%; P = .40). Findings were unchanged after multivariate adjustment: patients with mental illness had lower odds of LVEF evaluation (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.87) but comparable rates of ACE inhibitor prescription (0.96; 0.80-1.14). Patients with mental illness diagnoses had higher crude rates of 1-year all-cause readmission (73.7% vs 68.5%; P < .001), which persisted after multivariate adjustment (OR, 1.30; 95% CI, 1.21-1.39). Crude 1-year mortality was higher among patients with a mental illness diagnosis (41.0% vs 36.2%; P < .001). Presence of a comorbid mental illness diagnosis was associated with 1-year mortality after multivariate adjustment (OR, 1.20; 95% CI, 1.12-1.28).
Mental illness is commonly diagnosed among elderly patients hospitalized with heart failure. This subgroup receives somewhat poorer care during hospitalization and has a greater risk of death and readmission to the hospital.

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    • "Nine studies calculated quality metrics using administrative claims data (Banta et al., 2009; Blecker et al., 2010; Clark et al., 2009; Green et al., 2010; Kreyenbuhl et al., 2008; McGinty et al., 2012; Walkup et al., 2001, 2004) and eight studies obtained the data needed to calculate quality metrics through medical chart review (Bogart et al., 2006; Desai et al., 2002; R.J. Goldberg et al., 2007; R.W. Goldberg et al., 2007; Himelhoch et al., 2007; Kilbourne et al., 2008, 2011; Petersen et al., 2003; Rathore et al., 2008). Three studies used a combination of administrative claims and medical chart data (Druss et al., 2000, 2001; Rathore et al., 2008); and three used research-quality data collected in clinical trials or other studies (Frayne et al., 2005; Krein et al., 2006; Nasrallah et al., 2006). Summaries of results are presented in Tables 1–3. "
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    • "One study (Kisely et al., 2009) shows a clear disparity in receipt of care for those with mental disorder. Another three studies reveal a combination of positive and equivalent associations between mental disorder and receipt of medical care (Druss, Bradford, Rosenheck, Radford, & Krumholz, 2001; Petersen et al., 2003; Rathore et al., 2008). These differences raise the question as to whether those with mental disorder are receiving the same level of care, relative to clinical need, that is afforded the general population. "
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    • "Stigma and discrimination are well-documented [39-43] making reticence a self-protecting impulse for some respondents. However, reticence was expressed for sharing data about social and behavioral health problems that are prevalent, poorly screened, and related to service use and adherence generally [44-47]. Thus, reticence may handicap decision making by clinical and public health authorities whose actions are guided by patient-reported and/or shared data, and could undermine use of the PCHR as a virtual medical home that serves as a bridge for collaborating clinicians [48]. "
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