AT ANA 2016

BALTIMORE (FRONTLINE MEDICAL NEWS) – Patients admitted with acute ischemic stroke (AIS) with preexisting major depressive disorder (MDD) are less likely to die while in the hospital but are often hospitalized longer and are more likely to need specialty care when they are discharged, in comparison to similar patients without depression in the National Inpatient Sample.

“Our study displayed an increasing proportion of patients with MDD admitted due to AIS in the last decade with lower mortality but higher morbidity post stroke. In addition, there was less utilization of thrombolysis in this population,” study presenter Arpita Hazra, MD, Northwell Health, Jersey City, N.J., said at the annual meeting of the American Neurological Association.

The influence of MDD following a stroke on patient outcome has been well studied. However, the influence of preexisting MDD on immediate and longer-term outcomes of AIS is unclear. To provide clarity, Dr. Hazra and her colleagues used recent data from more than 4.3 million hospital AIS-related admissions identified in the United States between 2002 and 2012 in the National Inpatient Sample. Nearly 372,000 (8.6%) of the patients had MDD, and the proportion of MDD-related cases rose from 6.4% in 2002 to 10.3% in 2012. The researchers acknowledged that this may not actually represent a real increase. It might reflect, at least in part, the increasing use of the diagnostic ICD-9-CM codes in that decade.

Thrombolysis was carried out in fewer depressed patients than in those without depression (3.8% vs. 4.8%; P less than .001). The odds of death during hospitalization were 36% less for patients with MDD. However, patients with MDD tended to be hospitalized longer than nondepressed patients (median 3.6 vs. 3.4 days; P less than .001) and were nearly 40% more likely to require specialty care following discharge.

“There is a need to explore the reasons behind this disparity in outcomes and thrombolysis utilization in order to improve poststroke outcome in this vulnerable population,” Dr. Hazra said.

At face value, the observation of decreased mortality in AIS patients with preexisting MDD was surprising, according to Dr. Hazra. She suggested that this may reflect prior hospital treatment for these patients, because of other comorbidities associated with depression.

Dr. Hazra reported having no financial disclosures.


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