Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure.
OBJECTIVE
To explore associations between psychiatric comorbidity and rehospitalization risk, length of hospitalization, and costs.


METHODS
Cross-sectional study of 1-year hospital administrative data.


METHODS
Claims-based study of older adults hospitalized in the United States.


METHODS
Twenty-one thousand four hundred twenty-nine patients from a 5% national random sample of U.S. Medicare beneficiaries aged 65 and older, with at least one acute care hospitalization in 1999 with a Diagnostic-Related Group of congestive heart failure.


METHODS
The number of hospitalizations, mean length of hospital stay, and total hospitalization costs in calendar year 1999.


RESULTS
Overall, 15.8% of patients hospitalized for heart failure (HF) had a coded psychiatric comorbidity; the most commonly coded comorbid psychiatric disorder was depression (8.5% of the sample). Most forms of psychiatric comorbidity were associated with greater inpatient utilization, including risk of additional hospitalizations, days of stay, and hospitalization charges. Additional hospitalization costs associated with psychiatric comorbidity ranged up to $7,763, and additional days length of stay ranged up to 1.4 days.


CONCLUSIONS
Psychiatric comorbidity appears in a significant minority of patients hospitalized for HF and may affect their clinical and economic outcomes. The associations between psychiatric comorbidity and use of inpatient care are likely to be an underestimate, because psychiatric illness is known to be underdetected in older adults and in hospitalized medical patients.
Sayers
Steven L
SL
VISN 4 Mental Illness, Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA. steven.sayers@va.gov
Hanrahan
Nancy
N
Kutney
Ann
A
Clarke
Sean P
SP
Reis
Brendali F
BF
Riegel
Barbara
B
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000150:complications*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare; D001523:Mental Disorders / Q000150:complications*; D012923:Social Class; D014481:United States