This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (122)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

Benjamin G. Druss, MD, MPH; David W. Bradford, PhD; Robert A. Rosenheck, MD; Martha J. Radford, MD; Harlan M. Krumholz, MD

JAMA. 2000;283:506-511.

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 113,653 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.

Author Affiliations: Departments of Psychiatry (Drs Druss and Rosenheck) and Epidemiology and Public Health (Drs Druss, Rosenheck, and Krumholz), Yale University School of Medicine, VA Northeast Program Evaluation Center and the VA-Connecticut Mental Illness Research, Education and Clinical Center (Drs Druss and Rosenheck), Yale-New Haven Hospital Center for Outcomes Research and Evaluation (Drs Radford and Krumholz), Section of Cardiovascular Medicine, Department of Medicine, Yale University (Drs Radford and Krumholz), New Haven, Conn; Qualidigm, Middletown, Conn (Drs Radford and Krumholz); and Center for Health Care Research, Medical University of South Carolina, Charleston (Dr Bradford).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Cardiovascular Procedures in Patients With Mental Disorders
Janet K. Young, David A. Foster, David Shander, and Benjamin G. Druss
JAMA. 2000;283(24):3198-3199.
EXTRACT | FULL TEXT  

RELATED ARTICLE

January 26, 2000
JAMA. 2000;283(4):547-548.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Unmet Need for Mental Health Care in Schizophrenia: An Overview of Literature and New Data From a First-Admission Study
Mojtabai et al.
Schizophr Bull 2009;35:679-695.
ABSTRACT | FULL TEXT  

Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies
Mitchell et al.
Br. J. Psychiatry 2009;194:491-499.
ABSTRACT | FULL TEXT  

Psychiatric Comorbidity and Mortality After Acute Myocardial Infarction
Abrams et al.
Circ Cardiovasc Qual Outcomes 2009;2:213-220.
ABSTRACT | FULL TEXT  

Work, Recovery, and Comorbidity in Schizophrenia
McGurk et al.
Schizophr Bull 2009;0:sbn182v1-sbn182.
ABSTRACT | FULL TEXT  

Health Care for Patients with Serious Mental Illness: Family Medicine's Role
Morden et al.
J Am Board Fam Med 2009;22:187-195.
ABSTRACT | FULL TEXT  

Premature Mortality From General Medical Illnesses Among Persons With Bipolar Disorder: A Review
Roshanaei-Moghaddam and Katon
Psychiatr. Serv. 2009;60:147-156.
ABSTRACT | FULL TEXT  

AAFP Guideline for the Detection and Management of Post-Myocardial Infarction Depression
Post-Myocardial Infarction Depression Clinical Pra
Ann Fam Med 2009;7:71-79.
FULL TEXT  

Mental Disorders, Quality of Care, and Outcomes Among Older Patients Hospitalized With Heart Failure: An Analysis of the National Heart Failure Project
Rathore et al.
Arch Gen Psychiatry 2008;65:1402-1408.
ABSTRACT | FULL TEXT  

Access to Medical Care Among Persons With Psychotic and Major Affective Disorders
Bradford et al.
Psychiatr. Serv. 2008;59:847-852.
ABSTRACT | FULL TEXT  

The Stigma of Families with Mental Illness
Larson and Corrigan
Acad. Psychiatry 2008;32:87-91.
ABSTRACT | FULL TEXT  

Cardiovascular Disease and Metabolic Risk Factors in Male Patients With Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder
Kilbourne et al.
Psychosomatics 2007;48:412-417.
ABSTRACT | FULL TEXT  

Inequalities in the primary care of patients with coronary heart disease and serious mental health problems: a cross-sectional study
Hippisley-Cox et al.
Heart 2007;93:1256-1262.
ABSTRACT | FULL TEXT  

Mental illness and cardiovascular mortality: searching for the links
Goldbloom and Kurdyak
CMAJ 2007;176:787-788.
FULL TEXT  

Medical comorbidity in women and men with bipolar disorders: a population-based controlled study.
Carney and Jones
Psychosom. Med. 2006;68:684-691.
ABSTRACT | FULL TEXT  

Disparities in Hospitalization for Diabetes Among Persons With and Without Co-occurring Mental Disorders
Sullivan et al.
Psychiatr. Serv. 2006;57:1126-1131.
ABSTRACT | FULL TEXT  

Treatment of Cardiac Risk Factors Among Patients With Schizophrenia and Diabetes
Weiss et al.
Psychiatr. Serv. 2006;57:1145-1152.
ABSTRACT | FULL TEXT  

From silos to bridges: meeting the general health care needs of adults with severe mental illnesses.
Horvitz-Lennon et al.
Health Aff (Millwood) 2006;25:659-669.
ABSTRACT | FULL TEXT  

Brief Reports: Use of Emergency Department Services for Somatic Reasons by People With Serious Mental Illness
Hackman et al.
Psychiatr. Serv. 2006;57:563-566.
ABSTRACT | FULL TEXT  

Disparities in Diabetes Care: Impact of Mental Illness
Frayne et al.
Arch Intern Med 2005;165:2631-2638.
ABSTRACT | FULL TEXT  

Metabolism, lifestyle and bipolar affective disorder
Morriss and Mohammed
J Psychopharmacol 2005;19:94-101.
ABSTRACT  

Influence of Age on Gender Differences in the Management of Acute Inferior or Posterior Myocardial Infarction
Martinez-Selles et al.
Chest 2005;128:792-797.
ABSTRACT | FULL TEXT  

Effects of Noncardiovascular Comorbidities on Antihypertensive Use in Elderly Hypertensives
Wang et al.
Hypertension 2005;46:273-279.
ABSTRACT | FULL TEXT  

Mental Disorders and Revascularization Procedures in a Commercially Insured Sample
Jones and Carney
Psychosom. Med. 2005;67:568-576.
ABSTRACT | FULL TEXT  

Prognostic Association of Depression Following Myocardial Infarction With Mortality and Cardiovascular Events: A Meta-analysis
van Melle et al.
Psychosom. Med. 2004;66:814-822.
ABSTRACT | FULL TEXT  

A Comparison of Type 2 Diabetes Outcomes Among Persons With and Without Severe Mental Illnesses
Dixon et al.
Psychiatr. Serv. 2004;55:892-900.
ABSTRACT | FULL TEXT  

Coronary artery disease and depression
Zellweger et al.
Eur Heart J 2004;25:3-9.
ABSTRACT | FULL TEXT  

Rethinking quality in the context of persons with disability
LAWTHERS et al.
Int J Qual Health Care 2003;15:287-299.
ABSTRACT | FULL TEXT  

Depression Predicts Revascularization Procedures for 5 Years After Coronary Angiography
Sullivan et al.
Psychosom. Med. 2003;65:229-236.
ABSTRACT | FULL TEXT  

Clinical Experience With the Management of Schizophrenia in the General Hospital
Freudenreich and Stern
Psychosomatics 2003;44:12-23.
ABSTRACT | FULL TEXT  

Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980-1998
LAWRENCE et al.
Br. J. Psychiatry 2003;182:31-36.
ABSTRACT | FULL TEXT  

Dopamine Antagonists and the Development of Breast Cancer
Wang et al.
Arch Gen Psychiatry 2002;59:1147-1154.
ABSTRACT | FULL TEXT  

Medical Comorbidity and Receipt of Medical Care by Older Homeless People With Schizophrenia or Depression
Folsom et al.
Psychiatr. Serv. 2002;53:1456-1460.
ABSTRACT | FULL TEXT  

Mental Disorders and Quality of Diabetes Care in the Veterans Health Administration
Desai et al.
Am. J. Psychiatry 2002;159:1584-1590.
ABSTRACT | FULL TEXT  

Antipsychotics and the Risk of Sudden Cardiac Death
Ray et al.
Arch Gen Psychiatry 2001;58:1161-1167.
ABSTRACT | FULL TEXT  

Depression in Patients Recovering From a Myocardial Infarction
Ziegelstein
JAMA 2001;286:1621-1627.
ABSTRACT | FULL TEXT  

Integrated Medical Care for Patients With Serious Psychiatric Illness: A Randomized Trial
Druss et al.
Arch Gen Psychiatry 2001;58:861-868.
ABSTRACT | FULL TEXT  

Quality of Medical Care and Excess Mortality in Older Patients With Mental Disorders
Druss et al.
Arch Gen Psychiatry 2001;58:565-572.
ABSTRACT | FULL TEXT  

Cardiovascular Procedures in Patients With Mental Disorders
Young et al.
JAMA 2000;283:3198-3199.
FULL TEXT  

Are Psychiatric Patients Receiving Poor Medical Care?
JWatch Psychiatry 2000;2000:8-8.
FULL TEXT  

Do Patients with Mental Disorders Get Less Cardiovascular Care?
JWatch General 2000;2000:4-4.
FULL TEXT  

Five-Year Risk of Cardiac Mortality in Relation to Initial Severity and One-Year Changes in Depression Symptoms After Myocardial Infarction
Lesperance et al.
Circulation 2002;105:1049-1053.
ABSTRACT | FULL TEXT