(006) Impacts of Psychiatric Disorders (Psychosis, Mood, And Anxiety Disorders) on Cardiovascular Diseases Outcomes: Insights from a Nationwide Database

Background:
Psychiatric disorders often coexist with cardiovascular diseases (CVD). The burden of psychiatric illnesses in those patients remains unclear. We sought to study the associations between psychiatric diseases and outcomes in patients with CVD including heart failure (HF), acute coronary syndromes (ACS) and atrial fibrillation/flutter (AF).

Methods:
We queried ICD-10 codes in the nationwide readmissions database (2016-2018) for patients with psychiatric disorders including psychotic (F20-29), mood (F30-39), and/or anxiety (F40-43) disorders who were primarily admitted for HF, ACS, and AF. Multivariable analysis, adjusting for age, gender, demographics, and HCUP comorbidities, assessed outcomes of index mortality, and 30-day non-elective readmissions.

Results:
Among 2,001,839 admissions for patients with psychiatric disorders and CVD, the mean age was 69±14 years, 56.2% were males, 9.6% had mood disorders, 7.2% had anxiety disorders, and 0.8% had psychotic disorders. Results show psychotic disorders were associated with longer hospital stay (Table 1).

In multivariable analysis, Mood and anxiety disorders were associated with lower in-hospital mortality compared with no psychiatric disorders in patients with HF, ACS and AF. Psychotic disorders were associated with lower mortality in ACS, but not in HF or AF (Figure 1A; attached link). All the studied psychiatric disorders (most notably psychotic disorders) were associated with significantly higher 30-day readmission rates among patients with HF, ACS and AF compared with no psychiatric disorders (Figure 1B; https://www.dropbox.com/s/2dtcll218jtyl78/Figure%20A%202.png?dl=0).

Table 1: Mean length of hospital stay (days)

	Psychotic Disorders	Mood Disorders	Anxiety Disorders	None
Heart Failure	6.6	5.4	5.8	5.5
Acute Coronary Syndrome	6.4	4.5	4.7	4.7
Atrial Fibrillation	5.5	3.6	3.4	3.3

Conclusion:
In patients with psychiatric illness admitted for CVD, the presence of psychiatric disorder widely was associated with higher readmission rates and largely lower in-patient mortality. Further studies are necessary to determine the effects of psychiatric disorders on outcomes in CVD.

References:

1. Gundugurti PR, Bhattacharyya R, Koneru A. Management of Psychiatric Disorders in Patients with Cardiovascular Diseases. Indian Journal of Psychiatry. 2022 Mar;64(Suppl 2):S355.

2. Howell S, Yarovova E, Khwanda A, Rosen SD. Cardiovascular effects of psychotic illnesses and antipsychotic therapy. Heart. 2019 Dec 1;105(24):1852-9.

3. Kilbourne AM, Morden NE, Austin K, Ilgen M, McCarthy JF, Dalack G, Blow FC. Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors. General hospital psychiatry. 2009 Nov 1;31(6):555-63.