“SEVERE MENTAL ILLNESS &
CONGESTIVE HEART FAILURE OUTCOMES
AMONG VETERANS”
by
Introduction
•Heart failure is leading cause of death among those
greater than 65 years of age.
Jim Banta
UCLA Committee members: Alexander Young,
Gerald Kominksi, William Cunningham
Ronald Andersen, Chair
Special thanks to:
SAMHSA – Dissertation Year Award
Mental Illness, Research, Education and Clinical Center –
West Los Angeles VA Medical Center – Technical Support
• Estimated annual US healthcare costs of $40 to
$55 billion.
• 5 to 25% of medical inpatients have a mental
illness.
• Mentally illness often associated with greater
mortality and unfavorable utilization.
METHODS
Research Questions
• Retrospective, cross- sectional design.
1. Is mental illness associated with less primary care?
• Selected all inpatient veterans in FY 2001 with
congestive heart failure (not just 428.xx).
2. Is mental illness associated with more readmission?
•VA National Patient Database: Inpatient (PTF) and
outpatient (OPC).
3. Is mental illness associated with more mortality?
•Index hospitalization – first CHF admit of the FY.
•Utilization one year pre index admission and one
year post index discharge.
METHODS
• Used a Behavioral Model Approach.
• Merged contextual data:
County/State of veteran’s primary residence
VAMC size, academic affiliation, experience
METHODS
•Hierarchical categorizing of mental illness
(ICD
- 9CM codes of 292 to 316)
•Dementia
•Severe Mental Illness
•Schizophrenia/PTSD/Bi- Polar
• Medical risk adjustment
Congestive Heart Failure Index
Elixhauser method – 22 of 30 dummy variables
•Depression
•Anxiety
•Other mental illness (excludes substance abuse)
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RESULTS
RESULTS
ODDS of Primary Care
Descriptive statistics
(n=15,685)
No mental illness
Dementia
SMI
Depression
Anxiety
% of
total
subjects
Mean
Age
68%
8%
6%
12%
3%
70
77
63
68
70
Died
during
study
12%
21%
12%
13%
15%
No Inpatient
Inpatient
(n=10,861)
(n=4,824)
Dementia
0.8
0.5***
SMI
2.2***
0.9
Depression
2.4***
1.0
Anxiety
4.4***
1.7
* p<0.05, ** p<0.01, *** p<0.001
RESULTS
RESULTS
ODDS of Readmission (within one year)
ODDS of Mortality (adjusting for utilization)
No utilization
in Model
Utilization in
model
Died in index
hospitalization
Died after
discharge
(n=14,760)
(n=14,760)
(n=15,685)
(n=14,760)
Dementia
1.1
1.0
Dementia
1.5**
1.5***
SMI
1.1
1.1
SMI
1.3
1.3
Depression
1.2**
1.2**
Depression
1.0
1.2
Anxiety
1.2*
1.2*
Anxiety
0.9
1.5*
* p<0.05, ** p<0.01, *** p<0.001
SUMMARY
Among inpatient veterans with heart failure:
• Veterans with a mental illness are MORE likely
to get primary care (except for those with
dementia).
• Veterans with depression and anxiety are MORE
likely to be readmitted.
• Veterans with dementia are MORE likely to die.
* p<0.05, ** p<0.01, *** p<0.001
SIGNIFICANCE
• Mental illness plays limited role in heart failure
outcomes within the VA system: suggests that quality
care is being provided to a vulnerable population.
• Greater emphasis on primary care may decrease
mortality among those with dementia.
• Greater monitoring after discharge may reduce
readmission and mortality among those with
depression or anxiety
• Earlier targeting of veterans with severe mental
illness may delay hospitalization for heart failure.
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