Abstract 18359: Association of Depressive Symptoms and Risk of 30- and 90-day Hospital Admissions in Patients With a New or Worsening Diagnosis of Peripheral Artery Disease

Abstract

Introduction: Patients diagnosed with Peripheral Artery Disease (PAD) often present with a complex profile of comorbidities, including a high mental health burden. Depressive symptoms are associated with worse long-term PAD outcomes, but it is unknown whether they translate into a higher short term hospital admission. Methods: Patients with a new or worsening PAD diagnosis (Rutherford 1-3) enrolled at US in the PORTRAIT registry from 2011-2015 were included. The 8-item Patient Health Questionnaire assessed depressive symptoms (scores 0 to 24, higher scores more depressive symptoms). The Youden Criterion based on time-dependent receiver operator curves was used to describe high vs. low-risk admission groups. Adjusted Cox regression models generated risk estimates associated with continuous PHQ-8 scores and all-cause, cumulative 30- and 90-day admissions based on patients’ medical records. Results: We included 669 patients in the analysis (mean age 68.6 ± 9.6 years, 57.6% male, 73.0% white). The mean PHQ-8 Score was 4.8 ± 5.2; 61.9% was classified as low- (PHQ-8 <5) vs. 38.1% high-risk (PHQ-8 ≥ 5) for admissions based on the Youden Criterion. Patients in the low-risk vs. high-risk group had admission rates of 7.7% [95% CI 5.5-10.7] vs. 12.9% [95% CI 9.5-17.5] at 30 days (p-value: 0.023) and 16.2 [95% CI 13.1-20.0] vs. 25.6% [95% CI 21.0-31.0] at 90 days (p=0.002). In the adjusted model, depressive symptoms (per 1-unit increase) were independently and proportionally associated with 30-day (HR=1.06, 95% CI 1.01-1.11; p=0.026) and 90-day (HR=1.04, 95% CI 1.01-1.08; p=0.021) admissions following PAD diagnosis (e.g. those with scores >20 had a >20% or >30% 30- and 90-day admission risk, respectively) (Figure 1). Conclusion: Thirty- and 90-day admission risk for patients with a new or worsening PAD diagnosis is high, especially for those with depressive symptoms. Value-based PAD care should include screening and integrated care pathways for depression to mitigate this risk.