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Background Psychiatric comorbidities significantly impact hospital resource utilization in patients hospitalized for heart failure (HF). Mental health conditions such as depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), schizophrenia, and substance use disorders (SUDs) can worsen HF outcomes through mechanisms including increased inflammation, reduced self-care behaviors, and poor medication adherence. These overlapping clinical challenges demand a better understanding of how specific psychiatric diagnoses influence hospital length of stay (LOS) and healthcare costs to inform targeted interventions.
Methods We performed a retrospective cohort analysis using the Nationwide Readmissions Database (NRD) from 2016 to 2022. Adults (≥18 years) admitted with a primary diagnosis of HF were included. Psychiatric comorbidities were identified using ICD-10 codes for depression, anxiety, bipolar disorder, PTSD, schizophrenia/psychotic disorders, and SUDs. Outcomes included adjusted hospital LOS and inflation-adjusted hospitalization costs, analyzed using multivariable linear regression controlling for demographic, socioeconomic, and hospital-level factors.
Results Among 31,886,859 weighted heart failure hospitalizations, anxiety was associated with increased LOS by 0.84 days (p<0.001) and higher costs by $2,348 (p<0.001). Depression increased LOS by 0.23 days (p<0.001) and decreased costs by $873 (p<0.001). Bipolar disorder had no significant effect on LOS (p=0.19) but was associated with a $2,480 cost reduction (p<0.001). Schizophrenia/psychotic disorders increased LOS by 1.47 days (p<0.001) and decreased costs by $149 (p=0.02). PTSD showed no significant change in LOS (p=0.60) but lowered costs by $752 (p<0.001). SUD was associated with decreased LOS by 0.47 days (p<0.001) and reduced costs by $1,512 (p<0.001).
Conclusion Psychiatric comorbidities have diagnosis-specific effects on hospital resource use in heart failure. Anxiety and depression increased LOS, but only anxiety raised costs. Schizophrenia/psychotic disorders had the largest LOS increase with minimal cost reduction. Bipolar disorder and PTSD reduced costs without affecting LOS, while SUD decreased both. These patterns suggest differing care needs and highlight the importance of tailored, diagnosis-specific strategies to optimize resource use, improve discharge planning, and address potential care gaps in this high-risk population.
