Introduction: Patients with heart failure (HF) are at a greater risk for readmission within 30 days of discharge. The negative effects of psychiatric disease and medical non-adherence on cardiovascular risk is documented. However, there is little known regarding the interplay of psychiatric factors, medical compliance, and HF readmissions.
Purpose: To determine the relation of active psychiatric disease (APD) to 30-day heart failure readmission
Methods: We retrospectively examined 127 consecutive patients admitted with the diagnosis of heart failure at our institution from January 1st to December 31st, 2016. Patients were excluded if they died within 30d after admission. Medications were recorded at discharge. Patients who were being treated for active psychiatric disease (excluding depression) were identified within our cohort. Patients were determined to be medically non-adherent by review of the medical record. Multivariate analysis was used to determine which covariates were independently associated with 30-day all-cause readmission.
Results: Mean age of the study subjects with APD was 58 ± 10 years, 65% were male (N=37). Mean age of the study subjects without APD was 61 ± 14 years and 63% were male (N=90). Patients with APD where most likely to be readmitted within 30 days (51% and 17%; p <0.001). APD was independently associated with 30-day all-cause readmission in our cohort (HR: 2.77; CI 1.45-5.27; p =0.002). APD had significant readmission rates throughout the entire month where patients without APD had higher readmission rates only during the first 10 days. Impressively 82% of patients with APD and history of medical non-adherence were readmitted within 30 days (See Figure 1).
Conclusions: Active psychiatric disease in HF patients is associated with increased 30-day all-cause readmission. Medical non-adherence portends even worse prognosis in patients with APD and HF.