Impact of comorbid depression on medical resource use and in-hospital death of patients with heart failure: A nationwide retrospective cohort study

BACKGROUND: Little is known about the psychiatric medications that nonpsychiatrists prescribe for inpatients with heart failure. OBJECTIVES: To identify the effect of comorbid depression on health resource utilization and outcomes for inpatients with heart failure. METHODS: Administrative data from 10,702 heart failure patients admitted to acute care hospitals in Japan between July and December 2008 were analyzed retrospectively. The primary outcomes were total medical charges, length of hospital stay (LOS) and in-hospital mortality. Patients were divided into three groups based on psychiatric prescriptions: no psychiatric prescriptions; antidepressants; and other psychiatric prescriptions. Generalized linear models with a log-link and a gamma distribution were used to determine the impact of psychiatric prescriptions on total medical charges and LOS. A logistic regression model was used to evaluate the relationship between the psychiatric prescription and in-hospital death. RESULTS: Three hundred thirty-three patients (3.1%) received at least one antidepressant prescription and 4968 (46.4%) received other psychiatric prescriptions. Compared with inpatients without psychiatric medications, those with antidepressants accumulated additional medical costs of US$85,653, stayed in the hospital 5.7 days longer and were 1.52 times more at risk for in-hospital mortality. CONCLUSION: Results indicate that comorbid depression increased medical resource usage, LOS and the risk of in-hospital death.