Depression and Anxiety are Associated with High Healthcare Resource Utilization among Adults with Congenital Heart Malformations

בתיה ספיר Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Ofra Kalter-Leibovici Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Dahlia Weitzman Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Morris Kahn & Maccabi institute for research and innovation, Maccabi Healthcare Services, Israel Leonard Blieden Adult Congenital Heart Disease Unit, Rabin Medical Center, Sorasky Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel Jonathan Buber Heart Institute, Sheba Medical Center, Ramat-Gan, Israel Alexander Dadashev Adult Congenital Heart Disease Unit, Rabin Medical Center, Sorasky Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel Efrat Mazor-Dray Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Avraham Lorber Pediatric Cardiology and GUCH Unit, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel Amiram Nir Department of Pediatric Cardiology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel Yaron Razon Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Adult Congenital Heart Disease Unit, Rabin Medical Center, Sorasky Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel Sergei Yalonetsky Pediatric Cardiology and GUCH Unit, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel Gabriel Chodick Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Morris Kahn & Maccabi institute for research and innovation, Maccabi Healthcare Services, Israel Rafael Hirsch Adult Congenital Heart Disease Unit, Rabin Medical Center, Sorasky Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel On behalf of the Israeli Congenital Heart Disease Research Grou for the Israeli Congenital Heart Disease Research Group The Israeli Congenital Heart Disease, Research group, Israel

Background: Adult congenital heart disease (ACHD) patients are at risk of anxiety and depression. In the general population anxiety/depression were reported to be associated with high healthcare resource utilizations. Little is known about the association between anxiety/depression and healthcare resource utilization among ACHD patients.

Methods: Analysis comprised 8334 ACHD patients, age ≥18 years, insured by Maccabi Health Services during the studied period (2007-2011). Anxiety/depression were determined by diagnosis (ICD-9: 296.2-296.36, 311, 300.0, 300.2, 300.4) and treatment (ATC code: N06A).

Findings: Anxiety/depression were documented among 2950 (35%) ACHD patients. Patients with anxiety/depression were significantly more likely to be women (61% vs. 45%), older (mean±SD: 53±18 vs. 45±17 years) and to have cardiac disease manifestations (such as arrhythmia, heart failure, cardiovascular and other heart disease) and co-morbidities than anxiety/depression free counterparts. During the studied period, more anxiety/depression patients consulted with a cardiologist (86% vs 79%), visited an emergency department (ED; 58% vs. 45%) or were hospitalized (53% vs 39%) than patients without anxiety/depression.

Healthcare utilization rates associated with anxiety/depression were age dependent, with the highest relative rates (RR) among younger adults and the lowest among older adults. The highest multivariable negative binomial adjusted RRs (95% confidence interval) were: 1.75 (1.58-1.95) for GP visits; 1.53 (1.26-1.86) for cardiology consultations; 1.52 (1.11-2.08) for ED visits; all among age 18-24 years, and 1.55 (1.35-1.79) for hospitalizations among age 25-44. Lowest RRs were: 1.11 (1.05-1.17); 1.00 (0.91-1.10); 1.34 (1.13-1.59); and 1.23 (1.07-1.41) respectively, among age 65 years or older.

Conclusions: ACHD patients with anxiety/depression have increased relative healthcare services utilization rates particularly among younger patients. Addressing patient psychosocial needs might save unnecessary utilizations and improve ACHD patient prognosis.

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