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Cognitive factors help predict heart patients’ readmission risk

Sunday September 22, 2013
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Heart patients’ mental states and thinking abilities may help predict whether early hospital readmission will follow their release after treatment, according to a small study.

The findings, published Sept. 9 on the website of the journal Psychosomatics, have important implications for the healthcare industry as it struggles to contain unnecessary costs, according to the study’s lead author, Mark W. Ketterer, PhD, a psychologist and administrator for Henry Ford Hospital in Detroit.

“Wasted resources have become a central concern in American healthcare, including readmission soon after a patient has been released from hospital care,” Ketterer said in a news release. “Because heart failure has one of the highest readmission rates of all conditions that have been studied in Medicare and Medicaid populations, we decided to focus on it and try to identify predictors for early readmission.”

Ketterer and colleagues found a psychiatric history of depression, anxiety and other mood disorders, and cognitive impairments may well be such predictors.

The researchers chose 84 patients who were admitted to Henry Ford Hospital for treatment of acute heart failure. Each was interviewed for basic clinical and demographic information and asked to complete several questionnaires measuring depression, anxiety and spirituality.

Their medical risk factors (such as comorbidities) and behavioral risk factors (such as depression and cognitive impairments including loss of reasoning, planning, forgetfulness and other reduced mental functions) were recorded, as were admissions during the past year and readmissions during the previous 30 days.

The patient group was 62% male, with an average age of 66. Central nervous system disorders — including Alzheimer’s disease, dementia, closed-head injury and others — were present in 21%. Nearly 70% lived with a family member, 24% acknowledged a psychiatric history, 36% used or had used antidepressants, 40% had coronary artery disease, 43% had diabetes, 86% had hypertension, 20% had chronic obstructive pulmonary disease, 48% had chronic kidney disease and 24% reported abusing alcohol or drugs.

The researchers found depression, a history of substance abuse and a history of coronary artery disease were related to hospital admissions during the previous year.

Factors in 30-day readmission rates included immediate memory problems and a history of psychiatric treatment and/or the use of an antidepressant.

The severity of heart failure was not a factor in either admission or readmission rates.

“Our results agree with several recent studies in finding an adverse impact of depression on admission and readmission rates,” Ketterer said in the release. “In addition, substance abuse and chronic kidney disease may also adversely impact these rates” in heart failure patients.

“Even severe heart disease, except in the extreme, appears to be manageable after release from the hospital unless it’s complicated by one or more of the behavioral factors.”

Perhaps most important in these findings is the relationship between emotional stress and/or cognitive impairment and early readmission to the hospital.

“Both suggest a possible way to predict readmission and avoid it,” Ketterer said.

Educating patients about their mental illness, involving live-in family members in helping with the patient’s medications and keeping medical appointments also may help reduce hospital readmissions, the authors concluded.

Study abstract: http://bit.ly/1b00Dlt.


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