Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure.
Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure.
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严重的精神疾病与患有心力衰竭的退伍军人再次入院的风险升高相关。
DOI：
10.1016/j.jpsychores.2024.111604
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发表时间：
2024
影响因子：
4.7
通讯作者：
Wu,Wen-Chih
中科院分区：
文献类型：
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作者：
Browne,Julia;Rudolph,JamesL;Jiang,Lan;Bayer,ThomasA;Kunicki,ZacharyJ;DeVito,AlyssaN;Bozzay,MelanieL;McGeary,JohnE;Kelso,CatherineM;Wu,Wen-Chih
目的成人严重精神疾病(SMI)患者心血管疾病，尤其是心力衰竭的发生率较高，可导致过早死亡。研究的目的是检查因心力衰竭住院而出院的SMI退伍军人90天和365天的全原因内科或外科再次住院。研究的目的是评估出院后180天的心脏康复活动，这是一种有效的心力衰竭干预措施。方法本研究使用2011年至2019年退伍军人健康管理局(VHA)和医疗保险和医疗补助服务中心的管理数据。在入院前一年评估SMI状态和医疗合并症。使用Cox比例风险模型(竞争死亡风险)来评估SMI状态和预后之间的关系。结果样本包括189,767名退伍军人，其中23,671人(12.5%)患有SMI。与没有SMI的退伍军人相比，有SMI的退伍军人在90天(16.1%比13.9%)和365天(42.6%比37.1%)有更高的再住院率。调整后，再入院风险仍然显著(90天：HR：1.07，95%CI：1.03，1.11；365天：HR：1.10，95%CI：1.07，1.12)。SMI状态与180天的心脏康复参与度无显著相关性(HR：0.98，95%CI：0.91，1.07)。结论SMI合并心力衰竭的退伍军人即使在调整后仍有更高的90天和365天的再住院率。基于SMI状态的心脏康复参与度没有差异。今后的工作应考虑更广泛的出院后干预措施，以了解再次入院的贡献者。
ObjectiveAdults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure.MethodsThis study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics.ResultsThe sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07).ConclusionsVeterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission.