Severe mental illness and mortality of hospitalized ACS patients in the VHA

Mary E Plomondon¹ , P Michael Ho¹^,2 , Li Wang³ , Gwendolyn T Greiner³ , James H Shore⁴ , Joseph T Sakai⁴ , Stephan D Fihn³ and John S Rumsfeld¹^,2

¹Cardiology Section, Denver VA Medical Center, Denver CO, USA

²Department of Medicine, University of Colorado Health Sciences Center, Denver CO, USA

³Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care Center, Seattle WA, USA

⁴Department of Psychiatry, University of Colorado Health Sciences Center, Denver CO, USA

author email corresponding author email

BMC Health Services Research 2007, 7:146doi:10.1186/1472-6963-7-146


Published:	18 September 2007

Abstract

Background

Severe mental illness (SMI) has been associated with more medical co-morbidity and less cardiovascular procedure use for older patients with myocardial infarction. However, it is unknown whether SMI is associated with increased long term mortality risk among patients presenting with acute coronary syndromes (ACS). We tested the hypothesis that SMI is associated with higher one-year mortality following ACS hospitalization.

Methods

All ACS patients (n = 14,194) presenting to Veterans Health Administration (VHA) hospitals between October 2003 and September 2005 were included. Survival analysis evaluated the association between SMI and one-year all-cause mortality, adjusting for demographics, co-morbidities, in-hospital treatment, and discharge medications.

Results

Overall, 18.4 % of ACS patients had SMI. Patients with SMI were more likely female, younger, Caucasian race, have a history of alcohol abuse, liver disease, dementia, hypertension and more likely to be a current smoker; however, prior cardiac history was similar between the 2 groups. There were no significant differences in cardiac procedure use, including coronary angiogram (38.7% vs. 40.3%, p = 0.14) or coronary revascularization (31.0% vs. 32.3%, p = 0.19), and discharge medications between those with and without SMI. One-year mortality was lower for patients with SMI (15.8% vs. 19.1%, p < 0.001). However, in multivariable analysis, there were no significant differences in mortality (HR 0.91; 95% CI 0.81–1.02) between patients with and without SMI.

Conclusion

Among ACS patients in the VHA, SMI is prevalent, affecting almost 1 in 5 patients. However, patients with SMI were as likely to undergo coronary revascularization and be prescribed evidence-based medications at hospital discharge, and were not at elevated risk of adverse 1-year outcomes compared to patients without SMI.