Depression is associated with longer emergency department length of stay in acute coronary syndrome patients

BACKGROUND: Patient demographic characteristics have been associated with longer emergency department (ED) treatment times, but the influence of psychosocial characteristics has not been assessed. We evaluated whether depression was associated with greater ED length of stay (LOS) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) patients presenting to a large metropolitan academic medical center. METHODS: We calculated ED LOS for NSTEMI or UA patients enrolled an observational cohort study by taking the difference between ED triage time in the medical record and time of transfer to an inpatient bed from standardized transfer documentation forms. Depression status was defined as current, past, or never by clinical interview and also by self-report on the Beck Depression Inventory. RESULTS: Participants were 120 NSTEMI/UA patients [mean age= 62, 36% women, 56% Hispanic, 26% Black/African American, 40% NSTEMI, mean global registry of acute cardiac events (GRACE) score= 93.9]. Mean ED LOS was 11.6 hours, SD= 8.3. A multiple linear regression model that included the above demographic and clinical variables, and time of presentation to ED, explained 11% of the variance in ED LOS, F (11, 108)= 2.35, p= .01, R(2) adj.= .11. Currently depressed patients spent 5.4 more hours (95% CI= .40, 10.4 hours) in the ED on average than patients who had never been depressed. CONCLUSIONS: Currently depressed NSTEMI/UA patients are in the ED for an average of 5 hours longer than those who have never been depressed. Further research is needed to identify the reasons for this difference.