1
|
Barry LE, Carter L, Nianogo R, O'Neill C, O'Shea E, O'Neill S. The association of comorbid dementia with length of stay, cost and mortality among older adults in US acute hospitals: An observational study. Arch Gerontol Geriatr 2024; 125:105487. [PMID: 38788369 DOI: 10.1016/j.archger.2024.105487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Although overall health and social care expenditures among persons with dementia are larger than for other diseases, the resource and cost implications of a comorbid diagnosis of dementia in acute hospitals in the U.S. are largely unknown. We estimate the difference in inpatient outcomes between similar hospital admissions for patients with and without comorbid dementia (CD). METHODS Inpatient admissions, from the U.S. National Inpatient Sample (2016-2019), were stratified according to hospital characteristics and primary diagnosis (using ICD-10-CM codes), and entropy balanced within strata according to patient and hospital characteristics to create two comparable groups of admissions for patients (aged 65 years or older) with and without CD (a non-primary diagnosis of dementia). Generalized linear regression modeling was then used to estimate differences in length of stay (LOS), cost, absolute mortality risk and number of procedures between these two groups. RESULTS The final sample consisted of 8,776,417 admissions, comprised of 1,013,879 admissions with and 7,762,538 without CD. CD was associated with on average 0.25 (95 % CI: 0.24-0.25) days longer LOS, 0.4 percentage points (CI: 0.37-0.42) higher absolute mortality risk, $1187 (CI: -1202 to -1171) lower inpatient costs and 0.21 (CI: -0.214 to -0.210) fewer procedures compared to similar patients without CD. CONCLUSION Comorbid dementia is associated with longer LOS and higher mortality in acute hospitals but lower inpatient costs and fewer procedures. This highlights potential communication issues between dementia patients and hospital staff, with patients struggling to express their needs and staff lacking sufficient dementia training to address communication challenges.
Collapse
Affiliation(s)
- Luke E Barry
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Laura Carter
- J.E. Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland
| | - Roch Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - Eamon O'Shea
- J.E. Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland
| | - Stephen O'Neill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK.
| |
Collapse
|
2
|
Chan JKN, Chu RST, Hung C, Law JWY, Wong CSM, Chang WC. Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull 2022; 48:981-998. [PMID: 35786737 PMCID: PMC9434477 DOI: 10.1093/schbul/sbac070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND HYPOTHESIS People with severe mental illness (SMI) may experience excess mortality and inequitable treatment following acute coronary syndrome (ACS). However, cardioprotective pharmacotherapy and SMI diagnoses other than schizophrenia are rarely examined in previous reviews. We hypothesized that SMI including bipolar disorder (BD) is associated with increased post-ACS mortality, decreased revascularization, and cardioprotective medication receipt relative to those without SMI. STUDY DESIGN We performed a meta-analysis to quantitatively synthesize estimates of post-ACS mortality, major adverse cardiac events (MACEs), and receipt of invasive coronary procedures and cardioprotective medications in patients with SMI, comprising schizophrenia, BD, and other nonaffective psychoses, relative to non-SMI counterparts. Subgroup analyses stratified by SMI subtypes (schizophrenia, BD), incident ACS status, and post-ACS time frame for outcome evaluation were conducted. STUDY RESULTS Twenty-two studies were included (n = 12 235 501, including 503 686 SMI patients). SMI was associated with increased overall (relative risk [RR] = 1.40 [95% confidence interval = 1.21-1.62]), 1-year (1.68 [1.42-1.98]), and 30-day (1.26 [1.05-1.51]) post-ACS mortality, lower receipt of revascularization (odds ratio = 0.57 [0.49-0.67]), and cardioprotective medications (RR = 0.89 [0.85-0.94]), but comparable rates of any/specific MACEs relative to non-SMI patients. Incident ACS status conferred further increase in post-ACS mortality. Schizophrenia was associated with heightened mortality irrespective of incident ACS status, while BD was linked to significantly elevated mortality only in incident ACS cohort. Both schizophrenia and BD patients had lower revascularization rates. Post-ACS mortality risk remained significantly increased with mild attenuation after adjusting for revascularization. CONCLUSIONS SMI is associated with increased post-ACS mortality and undertreatment. Effective multipronged interventions are urgently needed to reduce these physical health disparities.
Collapse
Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ryan Sai Ting Chu
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chun Hung
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jenny Wai Yiu Law
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- To whom correspondence should be addressed; Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: (852) 22554486, fax: (852) 28551345, e-mail:
| |
Collapse
|
3
|
Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations. Prog Cardiovasc Dis 2022; 73:24-31. [PMID: 35718115 DOI: 10.1016/j.pcad.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dementia and cardiovascular diseases contribute to a significant disability and healthcare utilization in the elderly. OBJECTIVE The in-hospital treatment patterns and outcomes of heart failure (HF) and acute myocardial infarction (AMI) are not well-studied in this population. METHODS We used the National Inpatient Sample database to identify AMI and HF hospitalizations in adults ≥65 years between 2016 and 2018. RESULTS A total of 2,466,369 HF hospitalizations (277,900 with dementia [11.3%]) and 1,094,155 AMI hospitalizations (100,365 with dementia [9.2%]) were identified. Patients with dementia were older (mean age 83.8 vs 78.6 years for HF, and 83.0 vs 75.8 years for AMI) with female predominance (59.0% for HF and 56.0% for AMI) than those without dementia. In adjusted analysis, patients with dementia had higher in-hospital mortality (HF 4.7% vs 3.1%, aOR 1.33 [1.27-1.39] and AMI 9.9% vs 5.9%, aOR 1.23 [1.17-1.30]), p < 0.001) and lower mechanical circulatory support utilization. Patients with AMI and dementia were less likely to receive revascularization (including percutaneous coronary intervention, coronary artery bypass grafting, and thrombolysis), vasopressors, and invasive mechanical ventilation. They had a longer mean length of stay (LOS) (5.5 vs 5.3 days for HF and 5.1 vs 4.8 days for AMI, p < 0.001 for both), a lower inflation-adjusted cost of care for AMI ($15,486 vs $23,215, p < 0.001), and higher rates of transfer to rehabilitation facilities. CONCLUSION Patients with dementia admitted for HF or AMI had higher in-hospital mortality, a longer LOS, and were less likely to receive aggressive revascularization interventions after AMI.
Collapse
|
4
|
Kallio M, Korkeila J, Malmberg M, Gunn J, Rautava P, Korhonen P, Kytö V. Impaired long-term outcomes of patients with schizophrenia spectrum disorder after coronary artery bypass surgery: nationwide case-control study. BJPsych Open 2022; 8:e48. [PMID: 35144708 PMCID: PMC8867870 DOI: 10.1192/bjo.2022.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with schizophrenia spectrum disorder have increased risk of coronary artery disease. AIMS To investigate long-term outcomes of patients with schizophrenia spectrum disorder and coronary artery disease after coronary artery bypass grafting surgery (CABG). METHOD Data from patients with schizophrenia spectrum disorder (n = 126) were retrospectively compared with propensity-matched (1:20) control patients without schizophrenia spectrum disorder (n = 2520) in a multicentre study in Finland. All patients were treated with CABG. The median follow-up was 7.1 years. The primary outcome was all-cause mortality. RESULTS Patients with diagnosed schizophrenia spectrum disorder had an elevated risk of 10-year mortality after CABG, compared with control patients (42.7 v. 30.3%; hazard ratio 1.56; 95% CI 1.13-2.17; P = 0.008). Schizophrenia spectrum diagnosis was associated with a higher risk of major adverse cardiovascular events during follow-up (49.9 v. 32.6%, subdistribution hazard ratio 1.59; 95% CI 1.18-2.15; P = 0.003). Myocardial infarction (subdistribution hazard ratio 1.86; P = 0.003) and cardiovascular mortality (subdistribution hazard ratio 1.65; P = 0.017) were more frequent in patients with versus those without schizophrenia spectrum disorder, but there was no difference for stroke. Psychiatric ward admission, antipsychotic medication, antidepressant use and benzodiazepine use before CABG were not associated with outcome differences. After CABG, patients with schizophrenia spectrum disorder received statin therapy less often and had lower doses; the use of other cardiovascular medications was similar between schizophrenia spectrum and control groups. CONCLUSIONS Patients with schizophrenia spectrum disorder have higher long-term risks of death and major adverse cardiovascular events after CABG. The results underline the vulnerability of these patients and highlight the importance of intensive secondary prevention and risk factor optimisation.
Collapse
Affiliation(s)
- Mika Kallio
- Department of Psychiatry, University of Turku and Turku University Hospital, Finland
| | - Jyrki Korkeila
- Department of Psychiatry, University of Turku and Turku University Hospital, Finland; and Department of Psychiatry, Hospital District of Satakunta, Finland
| | - Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Finland; and Turku Clinical Research Centre, Turku University Hospital, Finland
| | - Päivi Korhonen
- Turku Clinical Research Centre, Turku University Hospital, Finland; and Department of General Practice, University of Turku and Turku University Hospital, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Center for Population Health Research, Turku University Hospital and University of Turku, Finland; Administrative Center, Hospital District of Southwest Finland, Finland; and Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| |
Collapse
|
5
|
Hannoodee H, Al Khalili M, Theik NWY, Raji OE, Shenwai P, Shah R, Kalluri SR, Bhutta TH, Khan S. The Outcomes of Acute Coronary Syndrome in Patients Suffering From Schizophrenia: A Systematic Review. Cureus 2021; 13:e16998. [PMID: 34540400 PMCID: PMC8423112 DOI: 10.7759/cureus.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/05/2022] Open
Abstract
Acute coronary syndrome (ACS) is a principal cause of mortality and morbidity worldwide. Recent studies have suggested poorer outcomes in ACS patients who have a concurrent diagnosis of schizophrenia as compared with those without. However, the degree of interplay between schizophrenia and ACS remains poorly understood. For this reason, we conducted a systematic review on ACS outcomes in patients with schizophrenia by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We collected relevant data from PubMed, Cochrane Library, PubMed central, Jisc Library Hub Discover, and the National Library of Medicine (NLM) and performed a thorough quality appraisal. Fourteen shortlisted, relevant studies were meticulously reviewed. Mortality and major adverse cardiac events (MACE), bleeding, and stroke were more prevalent in patients with a schizophrenia diagnosis compared to those without. Additionally, schizophrenia patients received suboptimal care and follow-up when compared to patients without a psychiatric diagnosis. Clinicians need to be aware that patients with schizophrenia have worse outcomes following ACS which may relate to biological, health care, or patient-related factors.
Collapse
Affiliation(s)
- Hanan Hannoodee
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mahmoud Al Khalili
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nyein Wint Yee Theik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Oluwatimilehin E Raji
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Priya Shenwai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rutul Shah
- Internal Medicine, M.P. Shah Government Medical College, Jamnagar, IND
| | - Sahithi Reddy Kalluri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tinaz H Bhutta
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
6
|
Ronaldson A, Elton L, Jayakumar S, Jieman A, Halvorsrud K, Bhui K. Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003284. [PMID: 32925912 PMCID: PMC7489517 DOI: 10.1371/journal.pmed.1003284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.
Collapse
Affiliation(s)
- Amy Ronaldson
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lotte Elton
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Simone Jayakumar
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna Jieman
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
7
|
Chang WC, Chan JKN, Wong CSM, Hai JSH, Or PCF, Chen EYH. Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Psychotic Disorders: A Population-Based Cohort Study. Schizophr Bull 2020; 46:774-784. [PMID: 32083305 PMCID: PMC7342096 DOI: 10.1093/schbul/sbaa013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ischemic heart disease is the leading cause of mortality in psychotic disorders. There is a paucity of research comprehensively evaluating short-term mortality, cardiovascular complications, and treatment inequality after cardiac events in patients with psychotic disorders. This population-based cohort study examined 30-day and 1-year all-cause mortality, cardiovascular complication rates, 30-day and 1-year receipt of invasive cardiac procedures, and 90-day post-discharge cardioprotective medication treatment following admission for first-recorded acute coronary syndrome (ACS) among patients with psychotic disorders (n = 703) compared with patients without psychotic disorders (n = 66 989) between January 2006 and December 2016 in Hong Kong (HK). Study data were retrieved from territory-wide medical record database of public healthcare services to 7.5 million HK residents. Multivariate regression analyses (ORs and 95% CIs), adjusting for demographics and medical comorbidities, were conducted to evaluate associations between psychotic disorders and post-ACS outcomes. Our results showed that patients with psychotic disorders had higher 30-day (OR: 1.99 [95% CI: 1.65-2.39]) and 1-year (2.13 [1.79-2.54]) mortality, and cardiovascular complication rates (1.20 [1.02-1.41]), lower receipt of cardiac catheterization (30-d: 0.54 [0.43-0.68]; 1-y: 0.46 [0.38-0.56]), percutaneous coronary intervention (30-d: 0.55 [0.44-0.70]; 1-y: 0.52 [0.42-0.63]) and reduced β-blockers (0.81 [0.68-0.97]), statins (0.54 [0.44-0.66]), and clopidogrel prescriptions (0.66 [0.55-0.80]). Associations between psychotic disorder and increased mortality remained significant even after complications and treatment receipt were additionally adjusted. Our findings indicate that psychotic disorders are associated with increased risks of short-term post-ACS mortality, cardiovascular complications, and inferior treatment. Excess mortality is not substantially explained by treatment inequality. Further investigation is warranted to clarify factors for suboptimal cardiac-care and elevated mortality in psychotic disorders to enhance post-ACS outcome.
Collapse
Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,To whom correspondence should be addressed; Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: 852-22554486, fax: 852-28551345, e-mail:
| | - Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - JoJo Siu Han Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Philip Chi Fai Or
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| |
Collapse
|
8
|
Shao M, Tian H, Wang L, Jiang D, Ji F, Zhuo C. Mortality risk following acute coronary syndrome among patients with schizophrenia: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109737. [PMID: 31442555 DOI: 10.1016/j.pnpbp.2019.109737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/04/2019] [Accepted: 08/18/2019] [Indexed: 12/14/2022]
Abstract
Patients with schizophrenia have a higher incidence of coronary artery disease. This meta-analysis was performed to evaluate the influence of a prior diagnosis of schizophrenia on mortality following acute coronary syndrome (ACS). Relevant longitudinal follow-up studies were obtained via systematic search of PubMed and Embase databases. A random effect model was used to perform the meta-analysis. This meta-analysis included 3,611,343 hospitalized patients with ACS from nine follow-up studies. The results show that, in patients with schizophrenia, ACS was associated with a significantly higher risk of mortality (multivariate adjusted risk ratio [RR]: 1.66, p < .001) with significant heterogeneity (I2 = 93%) compared to the results of mentally healthy patients. Subgroup analyses demonstrated that patients with schizophrenia were associated with higher ACS mortality within one month (RR: 1.68, p < .001) and during a follow-up period of ≥one year (RR: 1.71, p = .01), in studies with (RR: 1.65, p = .06) and without the adjustment of revascularization treatments (RR: 1.68, p = .004), as compared with the results of mentally healthy patients. These results indicate that patients with schizophrenia have a higher than expected mortality risk in the case of acute coronary events.
Collapse
Affiliation(s)
- Mingjing Shao
- National Integrated Traditional and Western Medicine Center for Cardivascular Disease, China-Japan Friendship Hospital, Beijing 100101, China
| | - Hongjun Tian
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China
| | - Lina Wang
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou 325000, China
| | - Feng Ji
- Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining 272191, China
| | - Chuanjun Zhuo
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China; Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou 325000, China; Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining 272191, China; Department of China, Canada Biological Psychiatry Lab, Xiamen Xianyue Hospital, Xiamen 361000, China; Department of Psychiatry, College of Basic Medical Research, Tianjin Medical University, Tianjin 300000, China.
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW To identify recent advances in the field of dementia care in high-income countries. RECENT FINDINGS New national and international initiatives identified support the notion of an increased commitment to face the challenge of dementia care. Recent research has documented barriers and facilitators to provide good care, and provided data on the specific needs of caregivers; the needs for better training of general practitioners; the negative influence of behavioural and psychological symptoms of dementia (BPSD); the palliative care needs; and the increased risk of dementia associated with anxiety (the population-attributable fraction of Alzheimer's risk was 6.1%). Significant advances in new technologies applicable in the care of dementia have also been reported. SUMMARY The increased awareness of the needs in dementia care is promising, although the Organisation for Economic Co-operation and Development has alerted about the limited implementation of the programmes. Barriers and facilitators identified have implications for both clinical practice and research. Particular implications for psychiatric action have the findings on BPSDs and on the preventive potential of the treatment of anxiety detected in the community. The data on palliative care needs and particularly on the advances of new technologies also have clinical implications.
Collapse
|
10
|
Chen TT, Yang JJ, Hsueh YSA, Wang V. The effects of a schizophrenia pay-for-performance program on patient outcomes in Taiwan. Health Serv Res 2019; 54:1119-1125. [PMID: 31131891 DOI: 10.1111/1475-6773.13174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To examine the effects of a schizophrenia pay-for-performance (P4P) program on the health outcomes of patients in Taiwan. DATA SOURCES Seven years (2007-2013) of data from the National Health Insurance Administration (NHIA) databases were examined. STUDY DESIGN P4P patients included those who were treated at participating facilities and consecutively included in the regular group (classified by the NHIA). Non-P4P patients were treated at nonparticipating facilities and never included in the regular group. The caliper matching method and a generalized estimating equation were used to estimate difference-in-differences models (baseline year 2009) and examine the short- and long-term effects of the P4P program on adverse outcomes. PRINCIPAL FINDINGS The schizophrenia P4P program was associated with decreases in unscheduled outpatient visits (OR: 0.69, P < 0.001) and compulsory admissions (incidence rate ratio: 0.33, P < 0.05). However, this program was not associated with decreases in other outcomes including emergency department visits for any disease, admissions to an acute psychiatric ward, and readmission within 6 months. CONCLUSIONS Although the disease management component of the P4P program can be beneficial for compulsory admissions, more sophisticated activities, such as health promotion targeting disadvantaged patients, could be implemented to reduce the occurrence of complicated adverse outcomes.
Collapse
Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Jing-Jung Yang
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan, R.O.C.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C
| | - Ya-Seng Arthur Hsueh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Vinchi Wang
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, R.O.C.,Department of Neurology, Neurological Center, Cardinal Tien Hospital, New Taipei City, Taiwan, R.O.C
| |
Collapse
|
11
|
Attar R, Valentin JB, Freeman P, Andell P, Aagaard J, Jensen SE. The effect of schizophrenia on major adverse cardiac events, length of hospital stay, and prevalence of somatic comorbidities following acute coronary syndrome. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:121-126. [PMID: 30496375 DOI: 10.1093/ehjqcco/qcy055] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 11/13/2022]
Abstract
AIMS We aimed to investigate major adverse cardiac events (MACE: defined as all-cause mortality, re-infarction, and stroke), length of hospital stays (LOS), and comorbidities following acute coronary syndrome (ACS) in a population with schizophrenia. METHODS AND RESULTS This Danish register study included patients diagnosed with ACS in the period between 1995 and 2013 with a preceding diagnosis of schizophrenia (n = 726). Each patient was matched to a psychiatric healthy control 1:2 on sex, age, year of ACS diagnosis, and number of comorbidities (total n = 2178). After performing Cox regression and Kaplan-Meier analyses, we found that patients with schizophrenia had an increased risk of MACE [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.45-1.81], all-cause mortality (HR 2.54, 95% CI 2.22-2.90), and stroke (HR 1.51, 95% CI 1.15-1.99). No differences were found in the re-infarction rates and LOS between the populations. Patients with schizophrenia had higher prevalence's diabetes, anaemia, heart failure, cardiomyopathy, chronic obstructive lung disease, and stroke. Nonetheless, we found lower prevalence's of hypertension and hyperlipidaemia. CONCLUSION Schizophrenia is associated with an increased risk of MACE despite a lower prevalence of some diagnosed traditional cardiac risk factors which may indicate underdiagnosing of these. Awareness of treatment bias may improve this increased risk.
Collapse
Affiliation(s)
- Rubina Attar
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Hobrovej 18, Aalborg, Denmark.,Department of Cardiology, Clinical Sciences, Lund University, Skånes Universitetssjukhus, EA-blocket, Lund, Sweden
| | - Jan Brink Valentin
- Department of Clinical Medicine, Aalborg University, Hobrovej 18, Aalborg, Denmark.,Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University, Hobrovej 18, Aalborg, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Hobrovej 18, Aalborg, Denmark
| | - Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Skånes Universitetssjukhus, EA-blocket, Lund, Sweden.,Unit of Cardiology, Department of Medicine, Karolinska Institute, Heart and Vascular Division, Karolinska University Hospital, Norrbacka S1:02, Karolinska Universitetssjukhuset, Solna, Stockholm, Sweden
| | - Jørgen Aagaard
- Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Hobrovej 18, Aalborg, Denmark
| |
Collapse
|
12
|
Hoyer C, Schmidt HL, Kranaster L, Alonso A. Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke. Neuropsychiatr Dis Treat 2019; 15:1823-1831. [PMID: 31308675 PMCID: PMC6614829 DOI: 10.2147/ndt.s206771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE The comorbidity of psychiatric disorders and cerebrovascular disease appears to be complex with underlying bidirectional influences. Hitherto, research has focused mainly on the evaluation of stroke risk in particular psychiatric disorders; only a few studies have assessed their role in the acute natural history of stroke. The aim of this study was to provide a perspective on psychiatric premorbidity and its impact on stroke severity, psychiatric complications during the initial treatment phase, and the short-term functional outcome of stroke. PATIENTS AND METHODS We retrospectively studied the impact of a predocumented psychiatric diagnosis (PDPD) on stroke severity, short-term functional outcome, and psychiatric complications in a sample of 798 patients consecutively admitted for acute ischemic or hemorrhagic stroke by performing a chart review. Group comparisons (PDPD vs non-PDPD) with adjustment for covariates were carried out either using multivariate analysis of variance or logistic regression analysis. RESULTS More severe strokes (ie, mean National Institute of Health Stroke Scale score on admission 10.1±7.9 vs 7.5±7.4; F(10,796)=18.5, p<0.0001) and higher prevalence of poor outcome (73.7 vs 54.9%; OR: 2.6, standard error: 0.5, z=4.82, p<0.0001) was found in patients with a documented psychiatric diagnosis at the time of stroke, as well as a higher rate of psychiatric complications during the initial treatment phase (46.7 vs 28.9%; OR: -0.78, z=4.59, p<0.0001). CONCLUSION Our data have clinical implications in that they call for identification of psychiatric premorbidity or comorbidity through careful history-taking and particularly close monitoring for psychiatric complications with respect to their potentially negative impact on outcome after stroke.
Collapse
Affiliation(s)
- Carolin Hoyer
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hanna Luise Schmidt
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
13
|
Möllers T, Stocker H, Wei W, Perna L, Brenner H. Length of hospital stay and dementia: A systematic review of observational studies. Int J Geriatr Psychiatry 2019; 34:8-21. [PMID: 30260050 DOI: 10.1002/gps.4993] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. METHODS A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. RESULTS Fifty-two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was -2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was -2.9 to +12.4 and -11.2 to +21.8 days, respectively. CONCLUSIONS The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.
Collapse
Affiliation(s)
- Tobias Möllers
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Stocker
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Wenjia Wei
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|