ECT Cuts Hospital Readmissions for Severe Mood Disorders

Megan Brooks

June 28, 2017

At a time when many US hospitals are opting out of electroconvulsive therapy (ECT), results of a new study may provide a strong incentive to offer it. The findings suggest that broader availability of ECT may result in fewer readmissions among psychiatric inpatients with severe affective disorders.

The quasiexperimental study included 162,691 inpatients with severe affective disorders in nine states. The adjusted predicted proportion of patients who were readmitted within 30 days was 6.6% among those who received ECT compared with 12.3% among those who did not ― a statistically significant difference (risk ratio, 0.54; 95% confidence interval [CI], 0.28 - 0.81).

"The results of the present study add evidence that wider availability of ECT may result in up to 46% fewer inpatient readmissions within 30 days of discharge among individuals with severe affective disorders," report Eric Slade, PhD, of the Department of Psychiatry, University of Maryland School of Medicine in Baltimore, and colleagues.

The study was published online June 28 in JAMA Psychiatry.

Benefit Underrecognized

The benefit of ECT with respect to 30-day readmissions did not differ significantly by age or race/ethnicity but was relatively larger among men than women and among individuals with bipolar disorder and schizoaffective disorder than among those with major depressive disorder. White non-Hispanic patients and those with private insurance or Medicare insurance were more apt to receive ECT.

Yet in this large, multicenter sample of inpatients with severe affective disorders, only 1.5% (2486 of 162,691) underwent ECT during their index admission.

"ECT programs have been eliminated in many hospitals, perhaps as a result of hospitals having insufficient financial incentive to maintain these programs," Dr Slade told Medscape Medical News.

"Our results suggest that lower rates of inpatient readmission among individuals with severe affective disorders may be an underrecognized benefit of hospitals' ECT programs.

"If this result is independently confirmed, it would indicate that ECT programs help hospitals achieve their performance goals for lower 30-day inpatient readmission rates and are uniquely valuable for patients with severe affective disorders.

"As a result, from a healthcare system planner's perspective, sustaining ECT programs may be critically important for the overall performance of a healthcare system in a region or state," said Dr Slade.

ECT Efficacy "Incontrovertible"

The findings in this study should be interpreted in the context of a "large and diverse body of evidence regarding ECT efficacy," writes Harold Sackeim, PhD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University in New York City, in a linked editorial.

"The evidence indicating that ECT is effective in the treatment of mood disorders is diverse, long-standing, and incontrovertible. In both the short term and long term, it appears to exert greater benefit than pharmacological alternatives," says Dr Sackeim.

There likely are a variety of factors that contribute to the low and inconsistent rate of ECT use, he notes. "Perhaps the most important considerations are the stigma associated with receiving the treatment on the part of patients and in recommending or administering the treatment on the part of professionals. Nonclinical economic, cultural, and political factors greatly affect the availability and use of this intervention.

"Were we able to overcome these barriers, it is likely that untold numbers of patients would experience better outcomes by receiving an intervention that is often life altering and, for some, lifesaving," Dr Sackeim concludes.

The study had no commercial funding and the authors have disclosed no relevant financial relationships. Dr Sackeim served as a consultant for LivaNova (vagus nerve stimulation), MECTA Corporation (electroconvulsive therapy), and Neuronetics (transcranial magnetic stimulation). He has also consulted with or received research support from several brain stimulation companies and pharmaceutical companies. He is the originator of magnetic seizure therapy and is the inventor on a nonremunerative patent for focal electrically administered seizure therapy. He is also the inventor on a nonremunerative pending patent on titration in the current domain as a method for determining seizure threshold in electroconvulsive therapy.

JAMA Psychiatry. Published online June 28, 2017. Abstract, Editorial

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