Impact of depression on in-hospital outcomes for adults with type 2 myocardial infarction: A United States population-based analysis

Table 1 Demographic characteristics and comorbidities in type 2 myocardial infarction-related hospitalizations with vs without depression

	Depression		Total T2MI, n = 331145	P value
	No, n = 289740	Yes, n = 41405
Age at admission
Median (IQR)	73 (62-83)	71 (61-81)	73 (62-82)	< 0.001
18-44 years	5.4%	5.0%	5.3%
45-64 years	24.1%	27.6%	24.6%
≥ 65 years	67.3%	70.1%	70.5%
Sex				< 0.001
Male	54.6%	40.1%	52.8%
Female	45.4%	59.9%	47.2%
Race				< 0.001
White	68.7%	78.4%	69.9%
Black	16.9%	11.2%	16.2%
Hispanic	8.1%	6.1%	7.8%
Asian or Pacific Islander	2.8%	1.4%	2.6%
Native American	0.8%	0.9%	0.9%
Others	2.8%	2.0%	2.7%
Median household income quartile for patient zip code				< 0.001
0-25th	32.9%	31.2%	32.7%
26-50th	26.5%	27.2%	26.6%
51-75th	23.1%	23.6%	23.2%
76-100th	17.5%	17.9%	17.5%
Primary expected payer				< 0.001
Medicare	71.8%	73.5%	72.0%
Medicaid	10.4%	11.1%	10.5%
Private including HMO	12.5%	10.8%	12.3%
Self-pay	2.9%	2.1%	2.8%
No charges	0.2%	0.1%	0.2%
Others	2.2%	2.4%	2.2%
Type of admission				0.985
Non-elective	97.0%	97.0%	97.0%
Elective	3.0%	3.0%	3.0%
Location/teaching status of hospital				< 0.001
Rural	8.4%	9.0%	8.5%
Urban non-teaching	15.6%	15.2%	15.5%
Urban teaching	76.0%	75.8%	76.0%
Region of hospital				< 0.001
Northeast	22.9%	21.7%	22.8%
Midwest	23.1%	27.9%	23.7%
South	35.0%	33.4%	34.8%
West	19.0%	17.0%	18.7%
Comorbidities
Alcohol abuse	4.9%	0.6%	5.0%	< 0.001
Arthropathies	4.1%	5.8%	4.3%	< 0.001
Dementia	10.9%	15.8%	11.6%	< 0.001
Hypertension, complicated	49.9%	49.2%	49.8%	0.006
Hypertension, uncomplicated	19.9%	22.6%	20.2%	< 0.001
Diabetes with chronic complications	31.5%	32.4%	31.6%	< 0.001
Diabetes without chronic complications	9.0%	8.9%	9.0%	0.244
Hyperlipidemia	48.9%	56.5%	49.9%	< 0.001
Obesity	17.9%	21.3%	18.4%	< 0.001
Peripheral vascular disease	11.3%	11.6%	11.3%	0.095
Prior MI	12.2%	13.2%	12.3%	< 0.001
Prior TIA/stroke	8.6%	10.1%	8.8%	< 0.001
Drug abuse	5.0%	7.4%	5.3%	< 0.001
Tobacco use disorder	15.5%	19.4%	16.0%	< 0.001
Chronic pulmonary disease	31.4%	38.9%	32.3%	< 0.001
Hypothyroidism	15.0%	21.3%	15.8%	< 0.001
Other thyroid disorders	1.5%	1.9%	1.5%	< 0.001
Anxiety & fear related disorders	9.0%	39.3%	9.0%	< 0.001
Cancer	9.3%	7.7%	9.1%	< 0.001

P < 0.05 indicates statistical significance. IQR: Interquartile range; HMO: Health Maintenance Organization; MI: Myocardial infarction; PCI: Percutaneous coronary intervention; TIA: Transient ischemic attack; T2MI: Type 2 myocardial infarction.

Table 2 In-hospital outcomes in type 2 myocardial infarction hospitalizations in patients with vs without depression

	No depression (n = 289740)	Depression (n = 41405)	Total T2MI (n = 331145)	P value
All-cause mortality	8.4%	5.8%	8.1%	< 0.001
Cardiogenic shock	3.5%	2.2%	3.4%	< 0.001
Dysrrhythmia	43.8%	40.2%	43.3%	< 0.001
Cardiac arrest including ventricular fibrillation	3.4%	2.4%	3.3%	< 0.001
Stroke	5.3%	4.1%	5.2%	< 0.001
Disposition of patient				< 0.001
Routine	39.9%	36.4%	39.5%
Transfers to short-term hospitalization	3.5%	2.9%	3.4%
Transfer other includes: Skilled nursing facility, intermediate care facility, another type of facility	27.7%	32.7%	28.3%
Home health care	19.0%	20.7%	19.2%
Length of stay (days), median (IQR)	5 (3-9)	5 (3-8)	5 (3-9)	0.243
Total charges USD, median (IQR)	53592 (29003-105279)	50156 (28249-90301)	53139 (28872-103331)	< 0.001

P < 0.05 indicates statistical significance. IQR: Interquartile range; T2MI: Type 2 myocardial infarction.

Table 3 Multivariable odds ratios for type 2 myocardial infarction and subsequent major adverse cardiac outcomes associated with depression

Outcome	Predictor	Odds ratio	95% confidence interval	P value
T2MI	Depression	0.88	0.86-0.90	< 0.001
In T2MI patients
In-hospital all-cause mortality	Depression	0.75	0.67-0.83	< 0.001
Cardiogenic-shock	Depression	0.65	0.56-0.76	< 0.001
Cardiac arrest including ventricular fibrillation	Depression	0.77	0.67-0.89	0.001
Stroke	Depression	0.79	0.70-0.89	< 0.001

The multivariable logistic regression analysis was adjusted for a comprehensive set of covariates, including age category, gender, race, income quartile based on zip code, primary payer, and a variety of comorbidities and prior conditions. These comorbidities encompassed acquired immunodeficiency syndrome, alcohol abuse, arthritis, both complex and uncomplicated hypertension, complex and uncomplicated diabetes, hyperlipidemia, obesity, peripheral vascular disease, previous myocardial infarction, previous percutaneous coronary intervention, previous coronary artery bypass graft, drug abuse, tobacco use disorder, chronic lung disease, hypothyroidism, other thyroid disorders, prior transient ischemic attack or stroke without neurologic deficit, and cancer. T2MI: Type 2 myocardial infarction.