The Associations of Diagnoses of Fatigue and Depression With Use of Medical Services in Patients With Heart Failure

BACKGROUND

Fatigue and depression based on self-report and diagnosis are prevalent in patients with heart failure and adversely affect high rates of hospitalization and emergency department visits, which can impact use of medical services. The relationships of fatigue and depression to use of medical services in patients with preserved and reduced left ventricular ejection fraction (LVEF) may differ.

PURPOSE

We examined the associations of diagnoses of fatigue and depression with use of medical services in patients with preserved and reduced LVEF, controlling for covariates.

METHODS

Data were collected on fatigue, depression, covariates, and use of medical services. Patients (N = 582) were divided into 2 groups based on LVEF (<40%, reduced LVEF; ≥40%, preserved LVEF). Multiple linear regression analyses were used to analyze the data.

RESULTS

A diagnosis of fatigue was a significant factor associated with more use of medical services in the total sample (β = .18, P < .001, R = 54%) and patients with reduced LVEF (β = .13, P = .008, R = 54%) and also preserved LVEF (β = .21, P < .001, R = 54%), controlling for all covariates, but a diagnosis of depression was not.

CONCLUSIONS

This study demonstrates the important roles of a diagnosis of fatigue in use of medical services. Thus, fatigue needs to be assessed, diagnosed, and managed effectively.

Racial/Ethnic Disparities in Quality of Care for Cardiovascular Disease in Ambulatory Settings: A Review

Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. The objective of this review is to synthesize recent evidence on racial and ethnic disparities in management of CVD in the ambulatory setting. Database searches yielded 550 articles of which 25 studies met the inclusion criteria. Reviewed studies were categorized into non-interventional studies examining the association between race and receipt of ambulatory CVD services with observational designs, and interventional studies evaluating specific clinical courses of action intended to ameliorate disparities. Based on the Donabedian framework, this review demonstrates that significant racial/ethnic disparities persist in process and outcome measures of quality of ambulatory CVD care. Multimodal interventions were most effective in reducing disparities in CVD outcomes.

Differing Effects of Fatigue and Depression on Hospitalizations in Men and Women With Heart Failure

BACKGROUND

In patients with heart failure, worsening of signs and symptoms and depression can affect hospitalization and also each other, resulting in synergistic effects on hospitalizations. A patient's sex may play a role in these effects.

OBJECTIVES

To determine the effects of fatigue and depression on all-cause hospitalization rates in the total sample and in subgroups of men and women.

METHODS

A secondary analysis was done of data collected January 1, 2010, through December 31, 2012 (N = 582; mean age, 63.2 years [SD, 14.4]). Data were collected on fatigue, depression, sample characteristics, vital signs, results of laboratory tests, medications, and frequency of hospitalization. Patients were categorized into 4 groups on the basis of the International Classification of Diseases, Ninth Revision: no fatigue or depression, fatigue only, depression only, and both fatigue and depression. General linear regression was used to analyze the data.

RESULTS

In both the total sample and the subgroups, the number of hospitalizations in patients with both fatigue and depression was greater than the number in patients without either symptom. Among women, the number of hospitalizations in the fatigue-only group and in the depression-only group was greater than that in the group with neither symptom. In men, the number of hospitalizations in the fatigue-only group was greater than that in the group without either symptom.

CONCLUSION

Fatigue and depression do not have synergistic effects on hospitalization, but men and women differ in the effects of these symptoms on hospitalization.

Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis

Allied health services benefit the management of many chronic diseases. The effects of health insurance on the utilisation of allied health services has not yet been established despite health insurance frequently being identified as a factor promoting utilisation of medical and hospital services among people with chronic disease. The objective of this systematic review and meta-analysis was to establish the effects of health insurance on the utilisation of allied health services by people with chronic disease. Medline (Ovid Medline 1948 to Present with Daily Update), EMBASE (1980 to 1 April 2011), CINAHL, PsychINFO and the Cochrane Central Register of Controlled Trials were searched to 12 April 2011 inclusive. Studies were eligible for inclusion if they were published in English, randomised controlled trials, quasi-experimental trials, quantitative observational studies and included people with one or more chronic diseases using allied health services and health insurance. A full-text review was performed independently by two reviewers. Meta-analyses were conducted. One hundred and fifty-eight citations were retrieved and seven articles were included in the meta-analyses. The pooled odds ratio (95% CI) of having insurance (versus no insurance) on the utilisation of allied health services among people with chronic disease was 1.33 (1.16-1.52; P<0.001). There was a significant effect of insurance on the utilisation of non-physiotherapy services, pooled odds ratio (95% CI) 4.80 (1.46-15.79; P=0.01) but having insurance compared with insurance of a lesser coverage was not significantly associated with an increase in physiotherapy utilisation, pooled odds ratio (95% CI) 1.53 (0.81-2.91; P=0.19). The presence of co-morbidity or functional limitation and higher levels of education increased utilisation whereas gender, race, marital status and income had a limited and variable effect, according to the study population. The review was limited by the considerable heterogeneity in the research questions being asked, sample sizes, study methodology (including allied health service), insurance type and dependent variables analysed. The presence of health insurance was generally associated with increased utilisation of allied health services; however, this varied depending on the population, provider type and insurance product.