Depressive symptoms and health care within 30 days after discharge from a cardiac hospital unit.

OBJECTIVE: To determine the association between depressive symptoms in CHD patients and in- and outpatient health care utilization during the 30 days following treatment in a cardiac hospital unit. METHOD: The study sample consisted of 949 CHD patients who completed a measure of depressive symptom severity (the Patient Health Questionnaire [PHQ-9]). Cardiac disease severity and medical comorbidities were assessed by chart review. Follow-up questionnaires were mailed to patients assessing in- and outpatient health care. RESULTS: Among patients with elevated depressive symptoms (PHQ-9 score of ≥7), 19.9% had at least one outpatient hospital visit (hospital-based medical centers, outpatient clinics, and emergency departments) within the first 30 days after the initial hospitalization, compared to 11.8% of patients without depressive symptoms (p = 0.002). This association remained significant after adjustment for sociodemographic and medical covariates. Elevated depressive symptoms also predicted a higher number of outpatient physician visits (adjusted OR = 2.36; 95% CI 1.75 - 3.18; p < 0.001). Results were similar for the PHQ-9 continuous score. There was no association between depressive symptoms and re-hospitalizations. CONCLUSIONS: After hospitalization for cardiac care, patients with elevated depressive symptoms may be at higher risk for utilizing outpatient physician and outpatient hospital care. This is not explained by more severe cardiac disease or more comorbidities.

Physician specialty and long-term survival after myocardial infarction - A study including all German statutory health insured patients.

BACKGROUND: With a mortality rate above European average, myocardial infarction (MI) is the second most common cause of death in Germany. Data about post-MI ambulatory care and mortality is scarce. We examined the association between ambulatory treating physicians' specialty and the mortality of post-MI patients. METHODS: Medical claims data of all 17 German regional Associations of Statutory Health Insurance physicians were analyzed, which cover approximately 90% of the German population. Patients with a new diagnosis of a MI in 2011 were divided into treatment groups with and without ambulant cardiology care within the first year after MI diagnosis. Propensity-score matching based on socio-demographic and clinical variables was performed to achieve comparability between groups. The 18-month mortality rate was derived employing a validated method. RESULTS: 158,494 patients with a new diagnosis of MI had received post-MI ambulatory care in 2011. Half of them (51%) had at least one ambulatory contact with a cardiologist within the first year. During a follow-up of 18months, the mortality rate before and after propensity-score matching was 19% and 14% in patients without cardiology care and 6%, respectively, in patients with cardiology care (χ2=666.7; P<0.000 after propensity adjustment). Patients who only saw a cardiologist and had no additional contact to an ambulant general practitioner (GP)/internist within the first year did not have increased survival rates. CONCLUSIONS: Outpatient follow-up care by a cardiologist in combination with consultations of GP/internists within the first year may be of importance for the prognosis of MI patients.