Protty Majd B, Lacey Arron, Smith Dave, Hannoodee Sahar, Freeman Phillip
Institute of Population Medicine, Cardiff University, Wales, UK.
Swansea University, Swansea, UK.
Int J Cardiol. 2017 Jun 1;236:5-8. doi: 10.1016/j.ijcard.2017.01.067. Epub 2017 Jan 9.
Psychiatric and cardiac comorbidities form the top two budget categories for health systems in high-income countries with evidence that psychiatric pre-morbidities lead to worse outcomes in patients with acute coronary syndrome (ACS). There are no studies examining this relationship in a national multicentre population level study in the UK, and no studies examining their impact on length of in-hospital stay (LoS) in ACS. Recognizing at-risk populations and reducing LoS in ACS is an essential part of improving patient care and cost-effectiveness.
We investigated the impact of psychiatric diagnoses on morbidity, all-cause mortality and LoS amongst 57,668 ACS patients between Jan-2004 and Dec-2014 using the Secure-Anonymized-Information-Linkage (SAIL) databank. Demographics, admissions, cardiac and psychiatric comorbidities were identified using coded data.
There were a total of 3857 out of 57,668 patients who had a pre-morbid psychiatric diagnosis. The mean LoS in patients without psychiatric comorbidities was 9.78days (95% CI: 9.66-9.91). This was higher (p<0.01) in the presence of any psychiatric diagnosis (14.72), dementia (20.87), schizophrenia (15.67), and mood disorders (13.41). Patients with psychiatric comorbidities had worse net adverse cardiac events (HR 1.18, 95% CI: 1.16-1.21) and mortality rates (HR 1.26, 95% CI: 1.23-1.30).
Our results demonstrate that psychiatric comorbidities have a significant and clinically important impact on morbidity, mortality and LoS in ACS patients in Wales, UK. Clinicians' awareness and active management of psychiatric conditions amongst ACS patients is needed to reduce poor outcomes and LoS and ultimately the risk for patients and financial burden for the health-service.
在高收入国家，精神疾病和心脏疾病合并症是卫生系统预算最高的两大类别，有证据表明，急性冠状动脉综合征（ACS）患者的病前精神疾病会导致更差的预后。在英国，尚无全国多中心人群水平的研究来探讨这种关系，也没有研究考察它们对ACS患者住院时间（LoS）的影响。识别高危人群并缩短ACS患者的住院时间是改善患者护理和成本效益的重要组成部分。
我们使用安全匿名信息链接（SAIL）数据库，调查了2004年1月至2014年12月期间57668例ACS患者中精神疾病诊断对发病率、全因死亡率和住院时间的影响。使用编码数据确定人口统计学、入院情况、心脏和精神疾病合并症。
57668例患者中共有3857例有病前精神疾病诊断。无精神疾病合并症患者的平均住院时间为9.78天（95%CI：9.66 - 9.91）。在存在任何精神疾病诊断（14.72天）、痴呆（20.87天）、精神分裂症（15.67天）和情绪障碍（13.41天）的情况下，住院时间更长（p<0.01）。有精神疾病合并症的患者有更差的净不良心脏事件（HR 1.18，95%CI：1.16 - 1.21）和死亡率（HR 1.26，95%CI：1.23 - 1.30）。
我们的结果表明，精神疾病合并症对英国威尔士ACS患者的发病率、死亡率和住院时间有显著且临床上重要的影响。需要临床医生提高对ACS患者精神疾病状况的认识并进行积极管理，以减少不良结局和住院时间，最终降低患者风险和卫生服务的经济负担。
