Psychological distress in heart failure patients: Implications for healthcare utilization and expenditure

Psychological distress is prevalent among heart failure (HF) patients, yet its impact on healthcare expenditure and utilization remains understudied. The aim of this study was to investigate the prevalence of psychological distress in HF patients and its impact on healthcare expenditure and utilization.

We analysed data from the Medical Expenditure Panel Survey from January 2016 to December 2021, focusing on adults diagnosed with HF. We assessed the prevalence of psychological distress using the Kessler 6 (K6) questionnaire and examined its association with healthcare utilization and expenditures through multivariate regression models, adjusting for relevant covariates. Among 10 681 886 HF patients, 6.8% experienced psychological distress. The mean age was 69.9 years, and 50% were female. Multivariable analysis revealed significant associations between psychological distress and smoking (adjusted odds ratio [aOR] 2.87), Charlson comorbidity index ≥3 (aOR 3.05), and sleep disorders (aOR 2.82). Protective factors included exercise (aOR 0.40), higher education (aOR 0.89) and higher income levels (middle-income: aOR 0.19, high-income: aOR 0.20). HF patients with psychological distress incurred significantly higher annual total expenses ($14 709, p < 0.01), with inpatient costs ($6014, p = 0.02) and office-based expenses ($3993, p = 0.04) being notably elevated. Additionally, these patients exhibited more frequent annual emergency room visits (0.07 visits, p < 0.01), hospital discharges (0.2 discharges, p = 0.01), and nights spent in the hospital (1.4 nights, p < 0.01).

Psychological distress in HF patients is associated with significantly higher medical expenditure and healthcare utilization. These findings underscore the need for integrated care approaches and present possible areas for intervention to address this significant healthcare burden.