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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).

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