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      Depression and race affect hospitalization costs of heart failure patients

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          Objective: Depression and anxiety are frequently observed in heart failure (HF) patients; however, the effect of such factors on hospitalization costs of HF patients, and whether such costs vary by race and gender remain poorly understood. This analysis delineated the prevalence of depression/anxiety among HF patients and estimated the effect of race and gender on hospitalization costs.

          Methods: We examined the 2008 files of the Tennessee Hospital Discharge Data System (HDDS) on patients (≥20 years of age) with a primary diagnosis of HF (ICD-9 codes 402, 404, and 428) along with demographic data, depression/anxiety diagnoses, hospital costs, and comorbidities. Among the HF sample ( n=16,889) 53% were female and 23% were black. Race and gender differences in hospital costs were evaluated for the following three groups: (1) HF patients with depression/anxiety (HF +D); (2) HF-only patients without depression/anxiety (HF O); and (3) HF patients with other mental diagnoses (HF +M).

          Results: HF was significantly ( p<0.000) higher among blacks compared to whites, and higher among males than females. Nearly 25% of HF patients had depression/anxiety (more whites and females were depressed). HF patients averaged more than 3 comorbidities (blacks had a greater number of comorbidities and hospitalization cost for the year). Costs were higher among HF +D patients compared to HF O patients. Among HF +D patients, costs were higher for black males compared with white males. These cost patterns prevailed largely because of higher comorbidities that required more re-admissions and longer hospital stays.

          Conclusion: Race and depression/anxiety are associated with increased hospitalization costs of HF patients. The higher costs among blacks reflect the higher burden of comorbidities, such as hypertension and diabetes, which calls for widespread dissemination, adoption, and implementation of proven interventions for the control of these comorbidities.

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          Most cited references 82

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          Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes.

          This article describes a meta-analysis of published associations between depression and heart failure (HF) in regard to 3 questions: 1) What is the prevalence of depression among patients with HF? 2) What is the magnitude of the relationship between depression and clinical outcomes in the HF population? 3) What is the evidence for treatment effectiveness in reducing depression in HF patients? Key word searches of the Medline and PsycInfo databases, as well as reference searches in published HF and depression articles, identified 36 publications meeting our criteria. Clinically significant depression was present in 21.5% of HF patients, and varied by the use of questionnaires versus diagnostic interview (33.6% and 19.3%, respectively) and New York Heart Association-defined HF severity (11% in class I vs. 42% in class IV), among other factors. Combined results suggested higher rates of death and secondary events (risk ratio = 2.1, 95% confidence interval 1.7 to 2.6), trends toward increased health care use, and higher rates of hospitalization and emergency room visits among depressed patients. Treatment studies generally relied on small samples, but also suggested depression symptom reductions from a variety of interventions. In sum, clinically significant depression is present in at least 1 in 5 patients with HF; however, depression rates can be much higher among patients screened with questionnaires or with more advanced HF. The relationship between depression and poorer HF outcomes is consistent and strong across multiple end points. These findings reinforce the importance of psychosocial research in HF populations and identify a number of areas for future study.
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            The influence of age, gender, and race on the prevalence of depression in heart failure patients.

            The goal of this study was to determine the prevalence of depression in an out-patient heart failure (HF) population; its relationship to quality of life (QOL); and the impact of gender, race, and age. Most studies of depression in HF have evaluated hospitalized patients (a small percentage of the population) and have ignored the influence of various patient characteristics. Although reported depression rates among hospitalized patients range from 13% to 77.5%, out-patient studies have been small, have reported rates of 13% to 42%, and have not adequately accounted for the impact of age, race, or gender. A total of 155 patients with stable New York Heart Association functional class II, III, and IV HF and an ejection fraction or =10. A total of 48% of the patients scored as depressed. Depressed patients tended to be younger than non-depressed patients. Women were more likely (64%) to be depressed than men (44%). Among men, blacks (34%) tended to have less depression than whites (54%). Depressed patients scored significantly worse than non-depressed patients on all components of both the questionnaires measuring QOL. However, they did not differ in ejection fraction or treatment, except that depressed patients were significantly less likely to be receiving beta-blockers. Depression is common in patients with HF, with age, gender, and race influencing its prevalence in ways similar to those observed in the general population. These data suggest that pharmacologic or non-pharmacologic treatment of depression might improve the QOL of HF patients.
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              Relationship of Depression to Increased Risk of Mortality and Rehospitalization in Patients With Congestive Heart Failure


                Author and article information

                Family Medicine and Community Health
                Compuscript (Ireland )
                June 2015
                July 2015
                : 3
                : 2
                : 39-47
                1Center for Prevention Research, Tennessee State University, Nashville, TN, USA
                2Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
                3Vanderbilt University Medical Center, Nashville, TN, USA
                4Department of Neurology, Memorial Hospital, Worcester, MA, USA
                Author notes
                CORRESPONDING AUTHOR: Baqar A. Husaini, Center for Preventive Research, Tennessee State University, 3500, John Merritt Blvd., Nashville, TN 37209, USA, Tel.: +615-210-1132, Fax: +615-963-5068, E-mail: bhusaini@ 123456tnstate.edu
                Copyright © 2015 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Self URI (journal page): http://fmch-journal.org/
                Original Research


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