Association between Psychiatric Disorders and the Incidence of Heart Failure in Women

Abstract

Background: Depression and anxiety occur more frequently in women and are associated with an increased risk of cardiovascular disease.

Objectives: Data on the association between these psychiatric conditions and the incidence of acute heart failure (HF) and how they influence heart failure outcomes in women are lacking. We investigated this potential relationship using data from the National Inpatient Sample.

Methods: We used ICD-10 codes to extract encounters for acute heart failure and/or the acute exacerbation of chronic heart failure, anxiety, and depression from the discharge data of the NIS from 2019 to 2020. We compared baseline characteristics and length of stay (LOS), cost of care (COC) and acute HF by depression/anxiety status for males and females and employed regression models to assess the influence of these psychiatric conditions on the outcomes.

Results: There were 6,394,136 encounters involving females, which represented 56.6% of the sample. The prevalence of depression and anxiety were 15.7% and 16.8%, respectively. Among females, the occurrence of acute CHF did not differ by depression or anxiety status. However, Takostubo cardiomyopathy was more prevalent in those with depression (0.3% vs. 0.2%, p = 0.003) and anxiety (0.3% vs. 0.2%, p = 0.03) compared to those without these conditions. Among those with depression, LOS was significantly longer (3 days IQR: 2-6, vs. 3 days IQR:2-5 days, p < 0.001). The COC was USD 1481 more in patients with depression. On the contrary, LOS and COC were significantly lower in those without anxiety.

Conclusions: Depression was associated with an increased LOS among both men and women and an increased cost of care among women. Anxiety was associated with a decreased LOS and cost of care among women, which may be related to an increased rate of against medical advice (AMA) discharges among this population. Further research is necessary to identify optimal management strategies for depression and anxiety among patients hospitalized with HF.

Keywords: anxiety; cost of care; depression; heart failure; length of stay; mortality.

Figure 1

Forest plot showing the adjusted odds of heart failure in the cohort. Key: λ = compared to whites; ψ = compared to 0–25th percentile of household income; § = compared to Medicare; BMI = body mass index.

Figure 2

Predictive margins with 95% confidence intervals for heart failure based on depression/anxiety status at various age groups.

Figure 3

Predicted length of stay (LOS) in days, with 95% confidence intervals for encounters based on the occurrence of heart failure and the presence or absence of depression and anxiety. Label “0” treats all observations as not having the condition and “1” as all observations having that condition.

Figure 4

Predicted cost of care (USD), with 95% confidence intervals for encounters based on the occurrence of heart failure and the presence or absence of depression and anxiety. Label with “0” treats all observations as not having the condition and “1” as all observations having that condition.