Elsevier

Mayo Clinic Proceedings

Volume 70, Issue 8, August 1995, Pages 734-742
Mayo Clinic Proceedings

Medical and Economic Costs of Psychologic Distress in Patients With Coronary Artery Disease

https://doi.org/10.4065/70.8.734Get rights and content

Objective

To determine the effect of psychologic distress, measured with a commonly used screening questionnaire, on 6-month morbidity and rehospitalization costs in coronary patients.

Design

Psychologic distress was determined by screening with the Symptom Checklist-90—Revised (SCL-90-R) self-report inventory during the second week of cardiac rehabilitation. Costs associated with cardiovascular rehospitalization during a 6-month follow-up period were recorded, and differences between “distressed” and “nondistressed” patients were analyzed statistically.

Material and Methods

The study cohort consisted of 381 patients (311 men and 70 women) referred for cardiac rehabilitation after an index hospitalization for unstable angina, myocardial infarction, coronary angioplasty, or coronary bypass procedure. Patients with SCL-90-R scores above the 90th percentile for outpatient adults were considered distressed (N = 41); patients with scores below this level were considered nondistressed (N = 340).

Results

The 6-month follow-up was complete in all but 1 of the 381 patients. Distressed patients had significantly higher rates of cardiovascular rehospitalization, any recurrent events, and recurrent “hard events” (cardiac death, myocardial infarction, or cardiac arrest and resuscitation) within 6 months after dismissal from their index hospitalization in comparison with nondistressed patients. Adjustment for other factors associated with a risk of early rehospitalization and recurrent events did not reduce the strength or significance of the association between psychologic distress and early cardiovascular rehospitalization or recurrent events. The mean rehospitalization costs were significantly higher in the distressed than in the nondistressed patients ($9,504 versus $2,146).

Conclusion

These data add support to the hypothesis that psychologic distress adversely affects the prognosis in coronary patients, confirm the added morbidity and rehospitalization costs attributable to psychologic distress, and suggest the potential for improving the prognosis in selected coronary patients by identification and appropriate treatment of psychologic distress.

Section snippets

BACKGROUND

Factors such as psychologic distress,1, 2, 3 depression,4, 5 and social isolation’1, 6, 7 have been shown to be independently associated with total mortality and cardiac death in patients with substantiated coronary artery disease. In addition, intervention for psychologic distress2, 3, 8 has been shown to decrease mortality after myocardial infarction.

To date, in only one previously published study in which psychologic distress was measured were all recurrent events and cardiovascular

PATIENTS AND METHODS

Study Group.—The study group consisted of 381 consecutive patients (311 men and 70 women) with coronary artery disease referred for cardiac rehabilitation after an index cardiac hospitalization.

Cardiac Rehabilitation.—The usual management during cardiac rehabilitation included monitored exercise sessions scheduled one to three times each week for approximately 6 to 12 weeks. Lectures on medications, exercise, stress reduction, and diet for the patients plus a special discussion group for both

RESULTS

Subject Characteristics.—The ages of patients in the study group ranged from 28 to 85 years. The index events included the following: unstable angina, 19; myocardial infarction, 73; emergent coronary angioplasty, 13; coronary artery bypass grafting, 118; myocardial infarction and angioplasty, 100; myocardial infarction and bypass surgical procedure, 45; angioplasty and bypass surgical procedure, 5; and myocardial infarction, angioplasty, and bypass surgical procedure, 8. The patients completed

DISCUSSION

The principal new finding in this study is that psychologic distress was associated with higher rehospitalization costs within 6 months after dismissal from an index hospitalization. Although new hard events were more common in the distressed than in the nondistressed patients during the 6 months of follow-up, we also found an excess of soft events and rehospitalizations in which no event occurred but which contributed, nonetheless, to the higher rehospitalization costs. Previous studies have

ACKNOWLEDGMENT

We thank Shawn E. Harris, Laurie L. Mather, and Candace L. Carlstrom for assistance with the data acquisition and analvsis.

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    This study was supported in part by the Mayo Foundation.

    *

    Current address: San Diego State University, San Diego, California.

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    Copyright © 1995 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.