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Table 4 The relative risks of health service utilization among those with (vs. without) depression after adjustment for baseline factors stratified by prognostic risk and functional capacity (among the entire AMI cohort, and among those in which death and recurrent AMI were excluded).*

From: The relationship between depressive symptoms, health service consumption, and prognosis after acute myocardial infarction: a prospective cohort study

 

Among the entire sample

Among those without death or re-infarction

 

Low risk

High risk

Low risk

High risk

Cardiac prognostic risk (GRACE Score⌷)

(n = 1079)

(n = 862)

(n = 995)

(n = 709)

Hospitalizationâ–¡

    

   Total hospitalization days#

1.45 (1.36–1.56)

1.13 (1.07–1.19)

1.43 (1.31–1.56)

1.15 (1.07–1.23)

   Cardiac-related days#

1.41 (1.29–1.53)

0.97 (0.90–1.04)

1.32 (1.19–1.47)

0.97 (0.87–1.08)

   Non-cardiac days

1.54 (1.37–1.74)

1.36 (1.27–1.47)

1.68 (1.44–1.95)

1.31 (1.19–1.43)

Ambulatory

    

   Cardiologist visits

1.16 (1.11–1.21)

1.13 (1.08–1.19)

1.17 (1.11–1.23)

1.11 (1.06 (1.18)

   Internist visits

1.12 (1.07–1.17)

1.04 (1.00–1.08)

1.04 (0.99–1.09)

1.14 (1.09–1.20)

   GP visits

1.15 (1.12–1.18)

0.97 (0.95–1.00)

1.17 (1.14–1.21)

0.92 (0.90–0.95)

   Total ER visits

1.21 (1.07–1.37)

0.98 (0.86–1.11)

1.24 (1.08–1.43)

1.01 (0.87–1.17)

 

High capacity

Low capacity

High capacity

Low capacity

Functional capacity (DASI score§

(n = 922)

(n = 1019)

(n = 856)

(n = 848)

Hospitalization§

    

   Total hospitalization days#

1.96 (1.79–2.16)

1.09 (1.04–1.14)

1.56 (1.38–1.77)

1.24 (1.17–1.32)

   Cardiac-related days#

1.13 (1.07–1.20)

0.91 (0.78–1.07)

1.17 (0.98–1.40)

1.19 (1.09–1.30)

   Non-cardiac days

3.99 (3.51–4.53)

1.04 (0.97–1.12)

2.14 (1.79–2.54)

1.33 (1.22–1.45)

Ambulatory

    

   Cardiologist visits

1.23 (1.15–1.32)

1.14 (1.10–1.18)

1.26 (1.17–1.35)

1.16 (1.11–1.21)

   Internist visits

1.33 (1.24–1.43)

1.02 (0.98–1.05)

1.37 (1.28–1.48)

1.09 (1.05–1.13)

   GP visits

1.28 (1.23–1.33)

0.98 (0.96–1.00)

1.25 (1.21–1.30)

1.00 (0.97–1.02)

   Total ER visits

1.49 (1.24–1.79)

1.00 (0.91–1.11)

1.66 (1.37–2.01)

1.02 (0.91–1.16)

  1. * All relative risks were adjusted for age, sex, income, pre-existing cardiovascular disease, pre-existing non-cardiovascular conditions, in-hospital processes of care, prognostic risk (GRACE and DASI). Abbreviation: AMI: Acute myocardial infarction. Interaction terms were included in models with the complete sample. Depression/GRACE score interactions were statistically significant for the following outcomes when death and recurrent AMI were included (General Practitioner (GP) Visits (P < 0.001) and when death and recurrent AMI were excluded: Total hospitalization days (P < 0.001); Total Cardiac-related hospitalization days (P < 0.001); Non-cardiac hospitalization days (P < 0.001); Cardiologist Visits (P = 0.02); Internist Visits (P = 0.05); GP visits (P < 0.001); and Total ER Counts (P = 0.002). Depression/DASI interactions were significant for the following outcomes when death and recurrent AMI were included: Total hospitalization days (P < 0.001); Non-cardiac hospitalization days (P < 0.001); GP Visits (P < 0.001); and Total Emergency Room (ER) Visits (P < 0.001). The depression/DASI interaction was also significant when death and recurrent AMI were excluded for the following outcomes: Total hospitalization days (P = 0.02); Non-cardiac hospitalization days (P = 0.004); GP Visits (P < 0.001) and Total ER Visits (P = 0.03). Depression status was based on the 9-item depression rating scale.
  2. ⌷ Abbreviation: GRACE – Global Registry of Acute Coronary Events.
  3. § Abbreviation: DASI – Duke Activity Status Index
  4. â–¡ Hospitalization days are a count of total days in hospital over the 18 month follow-up period and can accumulate from multiple hospitalizations.
  5. # Total and cardiac hospitalization results excluded recurrent AMI hospitalizations.
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BMC Health Services Research

ISSN: 1472-6963

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