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Abstract
BackgroundThe use of cardiovascular health services is greater among patients with depressive symptoms than among patients without. However, the extent to which such associations between depressive symptoms and health service utilization are attributable to variations in comorbidity and prognostic disease severity is unknown. This paper explores the relationship between depressive symptoms, health service cardiovascular consumption, and prognosis following acute myocardial infarction (AMI).MethodsThe study design was a prospective cohort study with follow-up telephone interviews of 1,941 patients 30 days following AMI discharged from 53 hospitals across Ontario, Canada between December 1999 and February, 2003. Outcome measures were post discharge use of cardiac and non-cardiac health care services. The service utilization outcomes were adjusted for age, sex, income, comorbidity, two validated measures of prognosis (cardiac functional capacity and risk adjustment severity index), cardiac procedures (CABG or PTCA) and drugs prescribed at discharge.ResultsDepressive symptoms were associated with a 24% (Adjusted RR:1.24; 95% CI:1.19–1.30, P < 0.001), 9% (Adjusted RR:1.09; 95% CI:1.02–1.16, P = 0.007) and 43% (Adjusted RR: 1.43; 95% CI:1.34–1.52, P < 0.001) increase in total, cardiac, and non-cardiac hospitalization days post-AMI respectively, after adjusting for baseline patient and hospital characteristics. Depressive-associated increases in cardiac health service consumption were significantly more pronounced among patients of lower than higher cardiac risk severity. Depressive symptoms were not associated with increased mortality after adjusting for baseline patient characteristics.ConclusionDepressive symptoms are associated with significantly higher cardiac and non-cardiac health service consumption following AMI despite adjustments for comorbidity and prognostic severity. The disproportionately higher cardiac health service consumption among lower-risk AMI depressive patients may suggest that health seeking behaviors are mediated by psychosocial factors more so than by objective measures of cardiovascular risk or necessity.
Highlights
The use of cardiovascular health services is greater among patients with depressive symptoms than among patients without
Data source and study sample This study is a sub-study of the Socio-Economic and Acute Myocardial Infarction Study (SESAMI) study, a prospective observational study of patients who were hospitalized for acute myocardial infarction (AMI) throughout Ontario, Canada[10]
There were no significant differences in baseline cardiovascular prognosis (GRACE scores 109.5 vs. 113.0, p = 0.22), but patients with depressive symptoms had poorer cardiovascular functional status (DASI score 11.2 vs. 19.6, p < 0.001; lower score indicates worse peak oxygen uptake)(Table 2)
Summary
The use of cardiovascular health services is greater among patients with depressive symptoms than among patients without. The extent to which such associations between depressive symptoms and health service utilization are attributable to variations in comorbidity and prognostic disease severity is unknown. Some authors advocate that increased health service consumption among cardiac-specific patients with depression is appropriate and concordant with their underlying cardiovascular prognosis[5]. Others contend that depressed patients seek more health care services regardless of illness severity. Evidence from utilization patterns of depressed patients in primary care settings suggest that depressed patients use more health care services than non-depressed patients regardless of medical illness severity [6]. Few studies have quantified the relationship between depressive symptoms, illness severity, and health service consumption
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