Severe mental illness, chest pain, and emergency response

How the prehospital chest pain triage contributes to inequities in cardiovascular outcomes remains poorly understood in patients with severe mental illness (SMI). We aimed to examine the association between SMI, emergency response, and cardiovascular health disparities in chest pain-related calls.

This registry-based cohort study included first-time chest pain-related calls to the Copenhagen Emergency Medical Services (emergency number and out-of-hours service) during the study period 2014-2018. We compared patients with SMI to patients without SMI (controls). We examined emergency response following telephone triage and diagnoses assigned during hospitalization by multivariable logistic regression.

Of 64,937 chest pain-related calls, 4,303 (7%) were from patients with SMI and 60,634 (93%) from controls. Patients with SMI more often received an acute ambulance dispatch than controls (66% vs 63%, OR: 1.24, 95%CI: 1.16-1.32). However, patients with SMI were less likely than controls to be admitted within 24 hours after the call (81% vs 85%, OR: 0.82, 95%CI: 0.76-0.89), assigned a cardiovascular diagnosis during hospitalization following the call (16% vs 26%, OR: 0.61, 95%CI: 0.56-0.67), or undergo revascularization within 30-days after the call (4% vs 7%, OR: 0.65, 95%CI: 0.55-0.78). The 30-days mortality was similar in patients with SMI and controls (1% vs 2%, OR: 1.18, 95%CI: 0.90-1.55).

Prehospital triage of chest pain did not contribute substantially to inequity in cardiovascular care of patients with SMI, whereas care disparities were observed in hospitalization, diagnostics, and treatment. Further examination of the symptom presentation is needed to improve identification of the acutely ill cardiovascular patients.