39 Stemi pathway progression for patients with severe mental illness

Introduction There is a gap in physical health outcomes between the general population and people with severe mental illnesses (SMI) – people with SMI face increased mortality at a young age and have a reduced life expectancy of 10–25 years. This indicates a need to improve physical healthcare for these patients and reduce these inequalities. The leading cause of poor health in people living with a diagnosis of an SMI is cardiovascular disease. In the setting of ST elevation myocardial infarction (STEMI), historical data suggests that there are significant differences in the care received by patients with SMI compared to the general population. We sought to identify whether these disparities still exist in the era of highly protocolised pathway-driven STEMI care. Methods We identified patients presenting with STEMI via the primary angioplasty pathway to King's College Hospital (KCH), direct from the community, with a diagnosis of STEMI from 2012 to 2020. We extracted cardiac-specific metrics from the percutaneous coronary intervention audit and general care data from the electronic health records. We used MedCAT, a natural language processing tool, to identify the sub-group of patients with SMI. The non-SMI STEMI patients were considered as the control group. Our primary investigation was into mortality outcomes for patients with SMI, following the intervention: 28-day in-hospital mortality and 1-year mortality. Our secondary investigations included potential delays to intervention, and other differences in these interventions, for patients with SMI. The specific metrics are listed below: Timings – symptom to balloon, call to balloon, and door to balloon. Procedure – number of stents, successful stent deployment, and achievement of TIMI 3 flow. Presenting symptoms and comorbidities for these patients For the mortality metrics, we used a logit regression to compare the SMI group to the general population. For the timings, we used a Poisson regression. For the procedure statistics, we used a logit regression for the TIMI 3 flow and a Poisson regression for the stent metrics. Age, sex, and ethnicity were adjusted for as confounders in all analyses. Finally, for the presenting symptoms and comorbidities we used a logit regression, adjusting for age. Results Following our filtering process, 2292 STEMI cases were identified over the 8-year period and 2.2% of these patients were reported to have SMI, with schizophrenia being the most common diagnosis (41.2%). The mean age for the overall population was 63.3 (SD 12.8), 73.9% were male, 73.8% were of white ethnicity, and the mean Index of Multiple Deprivation decile was 5 (SD 2.6). There were no statistically significant differences in 26 day and 1 year mortality between the SMI group and controls. Symptom-to-balloon time was statistically significantly longer in the SMI group compared to controls; however, the magnitude was very small (+1 minute, p < 0.05). There were no other significant differences in procedural metrics. Patients in the SMI group were more likely to have chronic obstructive pulmonary disease (COPD) compared to the general population (p < 0.05). We found patients in the SMI group were more likely to present to the catheterisation laboratory with cardiogenic shock (p < 0.05). Cardiac arrest was also numerically more likely in the SMI group, but not statistically significant (p < 0.1). Conclusions These findings provide evidence that the STEMI pathway in KCH provides effective acute care for patients with SMI, without excess mortality. A potential reason for these results is that the STEMI pathway is a highly structured tertiary healthcare service which, once entered, allows less opportunity for differences in treatment. Conflict of Interest None