Cognitive Impairment, Emotional Stress Linked to Readmission of Heart Patients

A recent study looks at how memory problems and emotional stress can often result in the readmission of heart patients to the hospital.

According to researchers at the Henry Ford Hospital, heart patients' mental state and thinking abilities may predict how costly and potentially dangerous early readmission could be.

Lead study author Mark W. Ketterer, Ph.D., a psychologist and administrator for Henry Ford, discusses the health implications for the health care industry and how these patients may be dealing with unnecessary costs.

"Wasted resources have become a central concern in American health care, including readmission soon after a patient has been released from hospital care," Dr. Ketterer said, via a press release. "Because heart failure has one of the highest readmission rates of all conditions that have been studied in Medicare and Medicaid populations, we decided to focus on it and try to identify predictors for early readmission."

Ketterer goes on to explain via the history of depression, anxiety and other mood disorders that various impairments can greatly affect a patient's ability to think, remember and reason based on various predictors.

"Given both the exorbitant fiscal costs and known health risks of hospitalization, including exposure to drug-resistant infections and medical errors, it could be well worth further study to test our findings." he adds, via the release.

Background information from the study notes that Medicare is penalizing hospitals for what it considers excessive readmission rates. Last month, Medicare said it will access $227 million in fines against hospitals in 49 states via part of an initiative to reduce the number of patients readmitted within a month. The study notes that 2,225 hospitals will see reduced payments for a year regarding Medicare, and Henry Ford Hospital is one of the hospitals that will see a reduction in payments starting Oct. 1.

Researchers chose 84 patients who were admitted to the Henry Ford Hospital for treatment of acute congestive heart failure, each of which were interviewed for basic clinical and demographic information via a questionnaire measuring anxiety, depression and spirituality.

Various medical risk factors may include depression and cognitive impairments including loss of reasoning, planning, forgetfulness and reduction of other mental functions.

The patient group was 62 percent male with an average age of 66. Central nervous system disorders-including various close-head injuries and other problems, represented approximately 21 percent. Findings also showed that nearly 70 percent lived with a family member; 24 percent acknowledged a psychiatric history; 36 percent used or had used antidepressants; 40 percent had coronary artery disease; 43 percent had diabetes; 86 percent had hypertension; 20 percent had chronic obstructive pulmonary disease; 48 percent had chronic disease and 24 percent were alcohol or drug abusers.

Researchers have found that depression along with a history of substance abuse and coronary artery disease were related to hospital admissions during the previous year.

Factors included in 30-day readmission rates regarding immediate memory problems and a history of psychiatric treatment and/or use of antidepressants.

"Our results agree with several recent studies in finding an adverse impact of depression on admission and readmission rates," Ketterer said, via the release. "In addition, substance abuse and chronic kidney disease may also adversely impact these rates in congestive heart failure patients.

"Even severe heart disease, except in the extreme, appears to be manageable after release from the hospital unless it's complicated by one or more of the behavioral factors."

However researchers find the most important link in the study to be emotional stress and/or cognitive impairment and early readmission.

More information regarding the study can be found in Psychosomatics.