Background. Psychiatric comorbidities are known to worsen cardiovascular (CV) outcomes, but their specific impact on all-cause hospital readmissions in heart failure (HF) populations remains unclear. While prior studies emphasize all-cause 30-day readmission, limited research explores how individual psychiatric conditions influence readmission risk over both short- and long-term periods. All-cause readmissions significantly contribute to healthcare utilization and financial burden, particularly among patients with complex psychosocial profiles. Identifying which psychiatric diagnoses are most strongly associated with all-cause readmission risk may inform the development of more precise and equitable post-discharge care strategies.

Methods. We conducted a retrospective cohort analysis using the Nationwide Readmissions Database from 2016 to 2022. A total of 31,886,859 weighted hospitalizations were included. Adult patients (≥18 years) hospitalized for HF were stratified by psychiatric comorbidity, including depression, anxiety, bipolar disorder, PTSD, schizophrenia/psychotic disorders, and substance use disorder. The primary outcomes were all-cause 30-day and 1-year readmissions. Multivariable Cox regression models adjusted for age, sex, hospital characteristics, income quartile, Charlson Comorbidity Index, and discharge disposition.

Results. Schizophrenia/psychotic disorders were associated with the highest adjusted risk of all-cause readmission at both 30 days (HR 1.05, 95% CI 1.05–1.06, p<0.001) and 1 year (HR 1.09, 95% CI 1.08–1.10, p<0.001). Bipolar disorder (HR 1.03 30-day, 1.06 1-year), PTSD (HR 1.03 30-day, 1.05 1-year), and substance use disorder (HR 1.02 30-day, 1.04 1-year) were also significantly associated with increased readmission risk (p < 0.001 for all). Depression was associated with a small but statistically significant reduction in 30-day readmission (HR 0.99, p < 0.001) but was not associated with 1-year readmission (HR 0.99, p = 0.69). Anxiety (HR 0.99 30-day, 1.00 1-year) was not significantly associated with readmission at either time point (p = 0.86 and p = 0.99, respectively).

Conclusion. Psychiatric comorbidities, particularly schizophrenia, bipolar disorder, PTSD, and substance use disorder, are independent risk factors for short- and long-term all-cause readmissions after HF hospitalization. These findings underscore the importance of integrating psychiatric care into cardiovascular discharge planning and transitional care models. Targeted interventions that address mental health instability in the early recovery period may reduce preventable readmissions and improve long-term cardiovascular outcomes in this high-risk population.