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Original Article
December 1, 2008

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

Author Affiliations

Author Affiliations: Section of Cardiovascular Medicine, Department of Internal Medicine (Messrs Rathore and Wang and Dr Krumholz), Section of Health Policy and Administration (Dr Krumholz), Department of Epidemiology and Public Health (Mr Rathore), and the Robert Wood Johnson Clinical Scholars Program (Dr Krumholz), Yale University School of Medicine, and Center for Outcomes Research and Evaluation, Yale–New Haven Hospital (Mr Wang and Dr Krumholz), New Haven, Connecticut; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Druss); Division of Cardiology, Department of Medicine, Denver Health Medical Center, and Division of Cardiology, Department of Medicine, University of Colorado Health Sciences Center, Denver (Dr Masoudi); and Colorado Foundation for Medical Care, Aurora (Dr Masoudi).

Arch Gen Psychiatry. 2008;65(12):1402-1408. doi:10.1001/archpsyc.65.12.1402

Objective  To evaluate the effect of a mental illness diagnosis on quality of care and outcomes among patients with heart failure.

Design  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.

Setting  Nonfederal US acute care hospitals.

Patients  A total of 53 314 Medicare beneficiaries.

Main Outcome Measures  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.

Results  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).

Conclusions  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.