Key result
Comorbid major depression linked to ~20% lower odds of coronary revascularization following AMI.
Why the study?
To assess the prevalence, temporal trends, and sex- and racial/ethnic differences in mental health disorders and outcomes among patients with acute MI in the United States.
Observational (n=6,117,804)
Yes
Effect estimate: OR 0.80 (95% CI 0.78-0.82)
Absolute Event Rate: 46.1% vs 50.6%
p-value: p=<0.001
There has been a significant increase in the prevalence of mental health disorders, including major depression and anxiety, among patients hospitalized for acute MI in the US between 2008 and 2017, which is associated with a lower likelihood of coronary revascularization.
May signal care disparities for depressed post-MI patients; leaves open causal factors and outcome impact.
To assess the prevalence, temporal trends and sex- and racial/ethnic differences in the burden of mental health disorders (MHD) and outcomes among patients with myocardial infarction (MI) in the United States. Using the National Inpatient Sample Database, we evaluated a contemporary cohort of patients hospitalized for acute MI in the United States over 10 years period from 2008 to 2017. We used multivariable logistic regression analysis for in-hospital outcomes, yearly trends and estimated annual percent change (APC) in odds of MHD among MI patients. We included a total sample of 6,117,804 hospitalizations for MI (ST elevation MI in 30.4%), with a mean age of 67.2 ± 0.04 years and 39% females. Major depression (6.2%) and anxiety disorders (6.0%) were the most common MHD, followed by bipolar disorder (0.9%), schizophrenia/psychotic disorders (0.8%) and post-traumatic stress disorder (PTSD) (0.3%). Between 2008 and 2017, the prevalences significantly increased for major depression (4.7%–7.4%, APC +6.2%, p < .001), anxiety disorders (3.2%–8.9%, APC +13.5%, p < .001), PTSD (0.2%–0.6%, +12.5%, p < .001) and bipolar disorder (0.7%–1.0%, APC +4.0%, p < .001). Significant sex- and racial/ethnic-differences were also noted. Major depression, bipolar disorder or schizophrenia/psychotic disorders were associated with a lower likelihood of coronary revascularization. MHD are common among patients with acute MI and there was a concerning increase in the prevalence of major depression, bipolar disorder, anxiety disorders and PTSD over this 10-year period. Focused mental health interventions are warranted to address the increasing burden of comorbid MHD among acute MI.
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Sreenivasan et al. (2020) conducted an observational in Acute myocardial infarction (n=6,117,804). Major depression vs. No mental health disorders was evaluated on Coronary revascularization (OR 0.80, 95% CI 0.78-0.82, p=<0.001). A comorbid diagnosis of major depression was associated with significantly lower odds of receiving coronary revascularization (OR 0.80) compared to patients without mental health disorders following acute myocardial infarction.
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