Abstract P370: Healthcare utilization in older adults with chronic heart failure and elevated depressive symptoms: Cardiovascular Health Study

Abstract

Background: Elevated depressive symptoms (EDS) are common in adults with heart failure (HF) and their joint prevalence is associated with worse short- (1 year) and long-term health outcomes. The contribution of EDS to healthcare costs and utilization in a contemporary population of older adults with HF is unknown.

Hypothesis: Adults with HF who report EDS will have higher annual healthcare costs and use more resources than their counterparts without EDS.

Methods: Participants from the Cardiovascular Health Study who developed HF between baseline and the 11-year follow up and whose data were linked to Medicare Part A and Part B claims were included in the analysis (n=441). HF was adjudicated based on review of medical records and physician questionnaires. EDS was determined if participants scored ≥8 on the abbreviated Centers for Epidemiologic Studies Depression scale. Medicare payments were adjusted using the Medical Consumer Price Index and represented in 2009 dollars. Annual healthcare utilization (i.e., total provider visits, inpatient and outpatient visits) is based on Part B. Linear regression with robust variance estimation was used to determine the relationship of EDS with medical costs or provider counts adjusted for confounders.

Results: Participants were 75.9 years old (SD= 5.3), 55% female, 15% black, and 147 (33%) had EDS. Within 2 years, 19% of patients with EDS died vs. 14% in those without EDS. Differences in annual costs between participants with and without EDS were not statistically significant. However, participants with EDS had more provider visits than their counterparts (Table).

Conclusion: Despite adults with HF and EDS using more healthcare resources than those without EDS, expenditures did not differ. Higher short-term mortality in adults with EDS could be an explanation.