The objective of Dr. Mansuri’s study was to determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis. While post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking. The investigators used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year’s 2002–2012. They identified AF and psychosis as primary and secondary diagnosis respectively using validated ICD-9-CM codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).
A total of 3,887,827 AF hospital admissions from 2002–2012 were analyzed of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.
This study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.
by Dr. Zeeshan Mansuri MD MPH
Psychiatry Resident, Texas Tech University Health Science Center (Midland, TX)