title: Increased morbidity, mortality and length of in-hospital stay for patients with acute coronary syndrome with pre-morbid psychiatric diagnoses.
abstract: BACKGROUND
  Psychiatric and cardiac comorbidities form the top two budget categories for health systems in high-income countries with evidence that psychiatric pre-morbidities lead to worse outcomes in patients with acute coronary syndrome (ACS). There are no studies examining this relationship in a national multicentre population level study in the UK, and no studies examining their impact on length of in-hospital stay (LoS) in ACS. Recognizing at-risk populations and reducing LoS in ACS is an essential part of improving patient care and cost-effectiveness.
  
  
  METHODS
  We investigated the impact of psychiatric diagnoses on morbidity, all-cause mortality and LoS amongst 57,668 ACS patients between Jan-2004 and Dec-2014 using the Secure-Anonymized-Information-Linkage (SAIL) databank. Demographics, admissions, cardiac and psychiatric comorbidities were identified using coded data.
  
  
  RESULTS
  There were a total of 3857 out of 57,668 patients who had a pre-morbid psychiatric diagnosis. The mean LoS in patients without psychiatric comorbidities was 9.78days (95% CI: 9.66-9.91). This was higher (p<0.01) in the presence of any psychiatric diagnosis (14.72), dementia (20.87), schizophrenia (15.67), and mood disorders (13.41). Patients with psychiatric comorbidities had worse net adverse cardiac events (HR 1.18, 95% CI: 1.16-1.21) and mortality rates (HR 1.26, 95% CI: 1.23-1.30).
  
  
  CONCLUSIONS
  Our results demonstrate that psychiatric comorbidities have a significant and clinically important impact on morbidity, mortality and LoS in ACS patients in Wales, UK. Clinicians' awareness and active management of psychiatric conditions amongst ACS patients is needed to reduce poor outcomes and LoS and ultimately the risk for patients and financial burden for the health-service.
authors.affiliation: Institute of Population Medicine, Cardiff University, Wales, UK. Electronic address: majd@protty.net.
authors.forename: Majd B
authors.initials: MB
authors.lastname: Protty
authors.affiliation: Swansea University, Swansea, UK.
authors.forename: Arron
authors.initials: A
authors.lastname: Lacey
authors.affiliation: Morriston Hospital, Swansea, Wales, UK.
authors.forename: Dave
authors.initials: D
authors.lastname: Smith
authors.affiliation: Stonebow mental health unit, Wye Valley NHS Trust, Hereford, UK.
authors.forename: Sahar
authors.initials: S
authors.lastname: Hannoodee
authors.affiliation: Institute of Population Medicine, Cardiff University, Wales, UK; Department of Cardiology, Aalborg University Hospital, Denmark.
authors.forename: Phillip
authors.initials: P
authors.lastname: Freeman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy; D000368:Aged; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology*; D009026:Mortality; D017063:Outcome Assessment, Health Care; D012559:Schizophrenia / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology
keywords: Acute coronary syndrome; Length of stay; Mortality; Population; Psychiatric