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Rathore SS, Wang Y, Druss BG, Masoudi FA, Krumholz HM. Mental Disorders, Quality of Care, and Outcomes Among Older Patients Hospitalized With Heart Failure: An Analysis of the National Heart Failure Project. Arch Gen Psychiatry. 2008;65(12):1402–1408. doi:https://doi.org/10.1001/archpsyc.65.12.1402
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.
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.
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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