Introduction:
There are minimal data describing the prevalence of mental health disorders (MHDO) in VAD-supported patients, or the association between MHDO and resource use or outcomes.
Methods:
This retrospective analysis utilizes all emergency department (ED) encounter-level data from the 2010-2017 Nationwide Emergency Department Sample (NEDS). Patients with VADs were identified using ICD-9/10 codes, as were associated MHDO diagnoses, which were categorized as depression/anxiety, suicide/self harm, bipolar/psychoses, and substance abuse. Outcomes and characteristics were compared for patients with and without a MHDO via descriptive statistics. Hospital admission and mortality occurring in ED or inpatient was investigated with logistic multivariable regression models adjusted for demographic and clinical characteristics.
Results:
Of the 47,543 encounters with VADs during the study period, 23% (n=11,103) had at least one MHDO. Depression/anxiety (82%) and substance abuse (22%) were the most prevalent MHDOs. Suicide attempt or self harm was the primary diagnosis for 20 (0.2%) encounters. Patients with MHDOs were more likely to be female (31% vs. 26%), younger (median age 59 vs. 61 years), and to have a non-MHDO chronic condition (77% vs 70%, P<0.0001 for all). Inpatient admission rates (79% vs. 59%) and charges ($33,421 (95% CI 15,074-73,517) vs. $21,346 (95% CI 5,290-56,910) were higher for those with MHDOs (both p<0.0001, Figure). However, mortality (2.0% vs. 3.3%, p=0.003) was lower. After adjusting for age, gender, and non-MHDO diagnoses, patients with MHDOs had higher admission rates (OR 2.3 (95% CI 1.8-2.9), p<0.001) and lower mortality (OR 0.63 (95% CI 0.42-0.94), p=0.03).
Discussion:
1 in 5 VAD-supported ED patient encounters also have a MHDO diagnosis. VAD-supported patients with a MHDO had higher resource use but lower mortality. These data underscore the need for greater attention to how MHDO may impact outcomes in VAD-supported patients.
