Abstract 20239: Increased Prevalence of Major Depressive Disorder in Patients Who Get Admitted With Acute Myocardial Infarction With Worse Outcomes
Objective: To determine the trends and impact on outcomes of Acute Myocardial Infarction (AMI) in patients with pre- existing Major Depressive Disorder (MDD).
Background: While post- AMI MDD has been extensively studied in the past, contemporary studies including temporal trends on the impact of pre- AMI MDD on AMI and post- AMI outcomes are largely lacking. We assessed the hypothesis that patients with pre-existing MDD have worse outcomes when admitted with AMI.
Methods: We used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) from year’s 2002 2012. We identified AMI and MDD as a primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD 9- CM) codes. We used the Cochrane -Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).
Results: We analyzed a total of 7,174,274 AMI hospital admissions from year’s 2002- 2012 of which 5.51% had MDD. Proportion of hospitalizations with MDD increased from 6.45% in 2002 to 11.87% in 2012 (p trend < 0.001). Utilization of Percutaneous Coronary Intervention (PCI) was lower in patients with MDD (34.37% vs. 40.52%, p < 0.001). Utilization of Coronary Artery Bypass Grafting (CABG) was lower in patients with MDD (7.34% vs. 9.26%, p < 0.001). In- hospital mortality was significantly lower in patients with MDD (aOR 0.706; 95%CI 0.677 0.736; p < 0.001) but discharge to specialty care was higher (aOR 1.30; 95%CI 1.268 1.332; p < 0.001). In addition, median length of hospitalization (3.05 vs. 2.91 days; p < 0.001) was higher and median cost of hospitalization (34,252 vs. 37,486; p < 0.001) was lower in hospitalizations with MDD.
Conclusions: In conclusion, our study displayed an increasing proportion of patients with MDD admitted due to AMI in the last decade with lower mortality but higher morbidity post-infarction. In addition, there was significantly less utilization of PCI and CABG in this population along with higher length of stay and lower median cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and PCI and CABG utilization in order to improve post -AMI outcomes in this vulnerable population.
Author Disclosures: Z. Mansuri: None. M.H. Gul: None. D. Patel: None. J. Shah: None. K. Chauhan: None. A. Patel: None.
- © 2016 by American Heart Association, Inc.