Victor Okunrintemi1, Javier Valero-Elizondo2, Erin D Michos3,4, Joseph A Salami5, Oluseye Ogunmoroti3, Chukwuemeka Osondu5, Martin Tibuakuu6, Eve-Marie Benson4, Timothy M Pawlik7, Michael J Blaha3, Khurram Nasir8. 1. Department of Internal Medicine, East Carolina University, Greenville, NC, USA. victor_okunrintemi@yahoo.com. 2. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA. 3. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 5. Baptist Health South Florida, Miami, FL, USA. 6. Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA. 7. Department of Surgery, Wexner Medical Center, Columbus, OH, USA. 8. Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA.
Abstract
BACKGROUND: Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. OBJECTIVE: To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed). DESIGN AND SETTING: The 2004-2015 Medical Expenditure Panel Survey (MEPS) was used for this study. PARTICIPANTS: Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. RESULTS: A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). LIMITATION: The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. CONCLUSION: Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.
BACKGROUND: Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. OBJECTIVE: To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed). DESIGN AND SETTING: The 2004-2015 Medical Expenditure Panel Survey (MEPS) was used for this study. PARTICIPANTS: Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. RESULTS: A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). LIMITATION: The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. CONCLUSION: Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.
Authors: Brett D Thombs; Eric B Bass; Daniel E Ford; Kerry J Stewart; Konstantinos K Tsilidis; Udita Patel; James A Fauerbach; David E Bush; Roy C Ziegelstein Journal: J Gen Intern Med Date: 2006-01 Impact factor: 5.128
Authors: Mary A Whooley; Peter de Jonge; Eric Vittinghoff; Christian Otte; Rudolf Moos; Robert M Carney; Sadia Ali; Sunaina Dowray; Beeya Na; Mitchell D Feldman; Nelson B Schiller; Warren S Browner Journal: JAMA Date: 2008-11-26 Impact factor: 56.272
Authors: Brett D Thombs; Peter de Jonge; James C Coyne; Mary A Whooley; Nancy Frasure-Smith; Alex J Mitchell; Marij Zuidersma; Chete Eze-Nliam; Bruno B Lima; Cheri G Smith; Karl Soderlund; Roy C Ziegelstein Journal: JAMA Date: 2008-11-12 Impact factor: 56.272
Authors: Victor Okunrintemi; Eve-Marie A Benson; Ouassim Derbal; Michael D Miedema; Roger S Blumenthal; Martin Tibuakuu; Oluseye Ogunmoroti; Safi U Khan; Mamas A Mamas; Martha Gulati; Erin D Michos Journal: Am J Prev Cardiol Date: 2020-08-27