Disparities in ST-elevation myocardial infarction diagnosis and management among patients with mental health conditions

Patients with mental health conditions (MHCs) experience delayed diagnosis and management. We aimed to assess whether these patients had longer treatment delays and poorer outcomes despite a dedicated ST-elevation myocardial infarction (STEMI) fast-track protocol. We analysed data from EVALFAST prospective registry of confirmed STEMI patients admitted directly to the catheterization laboratory at Fribourg Hospital since June 2008. Patients were classified into MHC cohort if their electronic health record documented any MHC at STEMI diagnosis. The primary endpoint was time from the first medical contact (FMC) to diagnosis. Secondary endpoints included FMC-to-balloon time, infarct size (peak CK-MB), and 30-day and 5-year major adverse cardiac and cerebrovascular events (MACCE). We used generalized linear models adjusted for demographics, risk factors, and presentation mode, and Cox regression for survival analyses. Among 1208 patients (excluding cardiac arrests), 147 (12.1%) had documented MHC. The MHC cohort had more women (36.7 vs. 23.3%; P = 0.002) and hypertension (57.8 vs. 47.8%; P = 0.03). After adjustment, FMC-to-diagnosis time was significantly longer in MHC patients [+16.43 min; 95% confidence interval (CI) +4.19 to +28.68; P = 0.009], resulting in prolonged FMC-to-balloon time (+18.63 min; 95% CI +4.86 to +32.39; P = 0.008). Diagnosis-to-balloon time did not differ (P = 0.420). Delays were pronounced among patients self-presenting to emergency departments (P = 0.002). Mental health condition patients had larger infarct sizes (peak CK-MB +71.3 U/L; 95% CI +18.0 to +124.6; P = 0.009) and higher risk of 30-day MACCE [adjusted hazard ratio (HR) 1.82; 95% CI 1.05-3.17; P = 0.034] and 5-year cardiovascular death (adjusted HR 2.04; 95% CI 1.18-3.55; P = 0.011). Among patients presenting with STEMI, being labelled with an MHC was linked with increased delays in early management, leading to greater infarct size and higher risk of adverse cardiovascular events. Mental health conditions were associated with increased long-term years cardiovascular death.