# Time to Death by Suicide in an Epidemiological Sample of Veterans With an Inpatient Hospitalization for Heart Failure

## TL;DR

This study found that Veterans hospitalized for heart failure who later died by suicide were younger, had fewer health issues, and had a longer time to death compared to those who died from other causes.

## Contribution

The study provides new insights into the demographic and clinical differences between Veterans who died by suicide versus other causes after heart failure hospitalization.

## Key findings

- Veterans who died by suicide were younger, had fewer comorbidities, and more depression diagnoses.
- Time to death after discharge was initially longer for suicide deaths but similar after adjusting for factors.
- Suicide deaths showed distinct demographic and healthcare utilization patterns compared to other causes.

## Abstract

Patients who have experienced an inpatient hospitalization for heart failure are at increased risk of mortality, particularly during the months following discharge. This study described patient characteristics associated with suicide death and examined the time course of death by suicide compared to that of other types of death amongst patients with a recent medical hospitalization for heart failure.

Using Department of Veterans Affairs (VA) electronic medical records from 2011 to 2020, we identified a cohort of Veterans hospitalized with a heart failure diagnosis who died after discharge. We merged the VA Mortality Database Record, a compilation of death sources and causes, with the VA electronic health record and compared characteristics of Veterans who died by suicide and by other causes.

In the cohort of 348,840 Veterans, 1,097 died by suicide and 347,743 died by other causes. Compared to those who died by other causes, Veterans who died by suicide were, on average, younger, had fewer comorbidities, more likely to have a depression diagnosis, more likely to be White, and had lower prior year healthcare costs (Standardized mean differences [SMD] ranged from 0.25 to 0.46). Unadjusted analyses showed longer length of time between hospital discharge and death for those who died by suicide compared to other causes (SMD = 0.18); however, analyses adjusting for comorbidities revealed no difference in time to death between those who died by suicide versus other causes.

Demographic, clinical, and healthcare utilization characteristics distinguished Veterans with heart failure who died by suicide from those who died by other causes. Time to death following hospital discharge did not differ between groups when accounting for relevant factors. Comprehensive suicide screening and intervention is needed following a heart-failure hospital discharge, particularly for Veterans at elevated risk.

In a large sample, this study found that patients with HF who died by suicide were younger, more likely to be White, and had fewer medical comorbidities than those who died by other causes. Those who died by suicide had a longer time to death, a finding which was ameliorated after accounting for relevant demographics, medical comorbidities, and healthcare utilization. These findings suggest there may be missed opportunities for clinical intervention among HF patients in the transition from medical hospitalization.