Mental disorders, receipt of acute cardiac care following myocardial infarction and the impact of the COVID-19 pandemic: a cohort study

Background and Aims People with a mental disorder have poorer myocardial infarction (MI) outcomes, with differences in cardiac care thought to be partly responsible. We compared receipt of guideline-informed acute MI care by mental disorder and assessed how the COVID-19 pandemic affected associations.

Methods We identified people with MI in England (November 2019 - February 2023) from the Myocardial Ischaemia National Audit Project (MINAP), ascertaining prior mental disorder from linked hospitalisation and primary care records and extracting care standards from MINAP. We used logistic regression to compare care standards for ST-elevation MI (STEMI) and non-STEMI (NSTEMI) between people with each of schizophrenia, bipolar disorder or depression versus those without any of these disorders, adjusting for confounders and investigating differences over time.

Results We included 131,075 NSTEMI and 79,045 STEMI cases. For NSTEMI, people with prior mental disorder had lower odds of angiography eligibility and receipt, cardiac ward admission and cardiac rehabilitation referral. Odds ratios (95% CIs) ranged from 0.25 (0.20, 0.31) for angiography receipt for schizophrenia to 0.92 (0.89, 0.96) for cardiac ward admission for depression. For STEMI, there was no evidence of care differences for depression; however, people with bipolar disorder were less likely to meet call-to-balloon targets and people with schizophrenia were less likely to be referred for cardiac rehabilitation and receive indicated secondary prevention medication. Disparities were generally unaffected by the COVID-19 pandemic.

Conclusions People with a mental disorder are less likely to receive guideline-informed MI care, with variation by MI type, care standard and mental disorder.

Summary We used linked electronic health records from over 200 000 NSTEMI and STEMI patients in England to compare receipt of guideline-informed care for myocardial infarction by mental disorder status and assess how the COVID-19 pandemic affected associations. We identified disparities in a range of care standards for both NSTEMI and STEMI, which were greatest for people with schizophrenia, but also evident for bipolar disorder and depression. Disparities were generally unaffected by the COVID-19 pandemic.