Medical and economic costs of psychologic distress in patients with coronary artery disease.
OBJECTIVE
To determine the effect of psychologic distress, measured with a commonly used screening questionnaire, on 6-month morbidity and rehospitalization costs in coronary patients.


METHODS
Psychologic distress was determined by screening with the Symptom Checklist-90--Revised (SCL-90-R) self-report inventory during the second week of cardiac rehabilitation. Costs associated with cardiovascular rehospitalization during a 6-month follow-up period were recorded, and differences between "distressed" and "nondistressed" patients were analyzed statistically.


METHODS
The study cohort consisted of 381 patients (311 men and 70 women) referred for cardiac rehabilitation after an index hospitalization for unstable angina, myocardial infarction, coronary angioplasty, or coronary bypass procedure. Patients with SCL-90-R scores above the 90th percentile for outpatient adults were considered distressed (N = 41); patients with scores below this level were considered nondistressed (N = 340).


RESULTS
The 6-month follow-up was complete in all but 1 of the 381 patients. Distressed patients had significantly higher rates of cardiovascular rehospitalization, any recurrent events, and recurrent "hard events" (cardiac death, myocardial infarction, or cardiac arrest and resuscitation) within 6 months after dismissal from their index hospitalization in comparison with nondistressed patients. Adjustment for other factors associated with a risk of early rehospitalization and recurrent events did not reduce the strength or significance of the association between psychologic distress and early cardiovascular rehospitalization or recurrent events. The mean rehospitalization costs were significantly higher in the distressed than in the nondistressed patients ($9,504 versus $2,146).


CONCLUSIONS
These data add support to the hypothesis that psychologic distress adversely affects the prognosis in coronary patients, confirm the added morbidity and rehospitalization costs attributable to psychologic distress, and suggest the potential for improving the prognosis in selected coronary patients by identification and appropriate treatment of psychologic distress.
Allison
T G
TG
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
Williams
D E
DE
Miller
T D
TD
Patten
C A
CA
Bailey
K R
KR
Squires
R W
RW
Gau
G T
GT
D000223:Adaptation, Psychological; D000368:Aged; D003327:Coronary Disease / Q000191:economics* / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011581:Psychological Tests; D012307:Risk Factors