Severe mental illness, chest pain, and emergency response

Area of Science:

• Cardiology
• Psychiatry
• Health Services Research

Background:

• Prehospital chest pain triage's role in cardiovascular outcome inequities for patients with severe mental illness (SMI) is unclear.
• Understanding these disparities is crucial for equitable emergency medical services.

Purpose of the Study:

• To investigate the association between SMI, emergency response, and cardiovascular health disparities in chest pain-related calls.
• To analyze how prehospital triage impacts cardiovascular care for patients with SMI.

Main Methods:

• A registry-based cohort study of first-time chest pain calls to Copenhagen Emergency Medical Services (2014-2018).
• Comparison of patients with SMI to those without SMI regarding emergency response and hospitalization diagnoses.
• Multivariable logistic regression analysis was used to examine emergency response and diagnostic assignments.

Main Results:

• Patients with SMI received ambulance dispatch more often (66% vs 63%).
• However, patients with SMI were less likely to be admitted within 24 hours (81% vs 85%), receive a cardiovascular diagnosis (16% vs 26%), or undergo revascularization (4% vs 7%).
• Thirty-day mortality was similar between groups (1% vs 2%).

Conclusions:

• Prehospital triage did not significantly contribute to cardiovascular care inequities for patients with SMI.
• Disparities exist in hospitalization, diagnostics, and treatment, highlighting the need for better identification of acutely ill cardiovascular patients.
• Further research into symptom presentation is required to improve care for this population.