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Mental disorders and use of cardiovascular procedures after myocardial infarction
B G Druss1, D W Bradford, R A Rosenheck
1Department of Psychiatry, Yale University School of Medicine, VA Northeast Program Evaluation Center, New Haven, Conn, USA. benjamin.druss@yale.edu
Insights
Patients with mental disorders were significantly less likely to receive cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), or coronary artery bypass graft (CABG) after acute myocardial infarction.
Area of Science:
- Cardiology
- Psychiatry
- Health Services Research
Background:
- Existing research indicates race and sex disparities in cardiovascular procedure rates.
- Comorbid mental disorders may be linked to reduced cardiovascular procedure rates due to clinical, socioeconomic, patient, and provider factors.
Purpose of the Study:
- To determine if patients with comorbid mental disorders are less likely to undergo cardiac catheterization or revascularization following acute myocardial infarction.
Main Methods:
- A retrospective cohort study analyzed data from medical charts and administrative files.
- The study included 113,653 patients aged 65+ hospitalized for acute myocardial infarction between February 1994 and July 1995.
- Comorbid mental disorders included schizophrenia, major affective disorder, substance abuse/dependence, and other mental disorders.
Main Results:
- Patients with any mental disorder were significantly less likely to undergo percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG).
- After adjusting for covariates, individuals with mental disorders were 41-78% as likely to undergo cardiac catheterization compared to those without.
- No significant difference in 30-day mortality was observed between patients with and without mental disorders.
Conclusions:
- Comorbid mental disorders are associated with substantially lower rates of coronary revascularization procedures.
- Further research is necessary to explore patient and provider factors contributing to these disparities and their impact on care quality and outcomes.
Context:
A number of studies have found race- and sex-based differences in rates of cardiovascular procedures in the United States. Similarly, mental disorders might be expected to be associated with lower rates of such procedures on the basis of clinical, socioeconomic, patient, and provider factors.
Objective:
To assess whether having a comorbid mental disorder is associated with a lower likelihood of cardiac catheterization and/or revascularization after acute myocardial infarction.
Design:
Retrospective cohort study using data from medical charts and administrative files as part of the Cooperative Cardiovascular Project.
Setting:
Acute care nongovernmental hospitals in the United States.
Patients:
National cohort of 113653 eligible patients 65 years or older who were hospitalized for confirmed acute myocardial infarction between February 1994 and July 1995.
Main Outcome Measures:
Likelihood of cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), or coronary artery bypass graft (CABG) surgery during the index hospitalization, comparing patients with and without mental disorders (classified as schizophrenia, major affective disorder, substance abuse/dependence disorder, or other mental disorder).
Results:
Compared with the remainder of the sample, patients with any comorbid mental disorder (n = 5365; 4.7%) were significantly less likely to undergo PTCA (11.8% vs 16.8%; P<.001) or CABG (8.2% vs 12.6%; P<.001). After adjusting for demographic, clinical, hospital, and regional factors, individuals with mental disorders were 41% (for schizophrenia) to 78% (for substance use) as likely to undergo cardiac catheterization as those without mental disorders (P<.001 for all). Among those undergoing catheterization, rates of PTCA or CABG for patients with mental disorders were not significantly different from rates for patients without mental disorders (for those with any mental disorder, P = .12 for PTCA and P = .06 for CABG). In multivariate models, the 30-day mortality did not differ between patients with and without mental disorders.
Conclusions:
In this study, individuals with comorbid mental disorders were substantially less likely to undergo coronary revascularization procedures than those without mental disorders. Further research is needed to understand the degree to which patient and provider factors contribute to this difference and its implications for quality and long-term outcomes of care.
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