Health care use in depressed, elderly, cardiac patients and the effect of antidepressant use

Am J Health Syst Pharm. 2009 Feb 15;66(4):366-72. doi: 10.2146/ajhp080092.

Abstract

Purpose: The association between a diagnosis of depression after a thromboembolic event (TEE) and an increase in acute health care use was examined.

Methods: A cohort of Medicare beneficiaries who were 65 years of age and older, who resided in the community, and who also experienced a TEE was constructed from the 1997-2001 Medicare Current Beneficiary Survey. Beneficiaries were assessed for TEEs and depression using the International Classification of Diseases, 9th Revision, Clinical Modification codes listed on Medicare claims. Time to first emergency department (ED) visit, inpatient hospitalization, and outpatient hospital visit were assessed using Cox-proportional hazard models. Counts of offices visits were assessed using negative binomial-regression models.

Results: Of the 7051 elderly patients included in the analysis, the total number with a claim for depression within 6 months of having a TEE was 380 (5.4%), including 259 antidepressant users (68.2% of depressed elders) and 198 selective serotonin-reuptake inhibitor (SSRI) users (76.4% of antidepressant users). Over half of elders with a depression claim (52.4%) had an inpatient hospitalization within 12 months of having a TEE compared to one third of the entire study sample (36.4%). Depressed elders had a 51% greater risk of hospitalization, a 56% greater risk of ED visits, and a 19% greater risk of outpatient visits. Antidepressant use did not affect the findings and was not found to be associated with health care use.

Conclusion: A claim for depression by Medicare patients was associated with the increased use of acute health care services, including hospitalizations and ED visits, in the 12 months following a TEE. Neither antidepressant use nor SSRI use was associated with an increase or reduction in risk of using such services.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antidepressive Agents / therapeutic use*
  • Delivery of Health Care / statistics & numerical data*
  • Depression / drug therapy
  • Depression / etiology*
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Male
  • Myocardial Infarction / psychology
  • Proportional Hazards Models
  • Serotonin Uptake Inhibitors / therapeutic use
  • Thromboembolism / complications*
  • Thromboembolism / psychology

Substances

  • Antidepressive Agents
  • Serotonin Uptake Inhibitors