Many ambulance dispatches to patients with severe mental illness and chest pain, but few cardiovascular diagnoses during hospitalization

Introduction Knowledge of prehospital care of patients with severe mental illness and cardiovascular disease is sparse. Hence, evidence is needed to guide future interventions to improve the care of these patients in prehospital settings. Purpose To examine the relationship between severe mental illness, emergency response, and cardiovascular health disparities in chest pain-related calls to the Emergency Medical Services. Methods This registry-based cohort study included chest pain-related calls to the Emergency Medical Services in Denmark, 2014-2018. Cases were patients with severe mental illness, including schizophrenia spectrum disorders, bipolar disorder, and depression. Controls were patients without severe mental illness. We examined emergency response following telephone triage and diagnoses assigned during hospitalization by sex- and age-adjusted logistic regression. Results Of 64,881 chest pain-related calls, 5,644 were from cases and 59,237 from controls. Cases were more often females (58% vs 50%) and were younger (median age 53 vs 56 years). Cases were less likely to be referred to the hospital after a chest pain-related call than controls (80% vs 83%, OR: 0.86, 95%CI: 0.80-0.92), see Figure 1. However, cases more often received an acute ambulance dispatch (67% vs 63%, OR: 1.25, 95%CI: 1.18-1.33). A cardiovascular diagnosis was less frequently assigned to cases during hospitalization than controls (13% vs 20%, OR: 0.65, 95%CI: 0.60-0.71). Conclusion In chest pain-related calls, severe mental illness was associated with fewer acute admissions, more frequent acute ambulance dispatches, and fewer cardiovascular diagnoses assigned in-hospital. Further investigation of prehospital care of this vulnerable patient group is needed to address these findings.