Influence of mental disorders on receipt of revascularization following hospitalization for myocardial infarction

Abstract

To determine if receipt of angioplasty (PTCA) and bypass graft surgery (CABG) was similar among privately insured subjects with any mental disorder (MD) and with specific MDs, compared with persons without MDs, during 1996 to 2001. Adults with an overnight hospitalization for myocardial infarction (MI) were analyzed. The MD cohort included all subjects with a MD claim filed prior to the index MI admission date. MD categorization was based on the most clinically prominent MD claim. Logistic regression was used to calculate odds ratios (OR) for receipt of PTCA and CABG after adjusting for demographic, hospitalization, and comorbidity variables. We identified 3870 adults hospitalized overnight for MI, of which 1257 (32%) had a preexisting MD. MD subjects were more likely to be younger, women, and urban residents and to have MI-related comorbidity (e.g., hypertension, obesity, hypercholesterolemia). Subjects with MDs were as likely to have received PTCA (OR = 1.14; 95% CI = 0.98–1.32) and CABG (OR = 0.89; 95% CI = 0.71–1.11) as subjects without MDs, after adjusting for demographic, hospitalization, and comorbidity measures. Subjects with adjustment disorders (OR = 0.23; 95% CI = 0.06–0.88) and psychotic disorders (OR = 0.03; 95% CI = 0.00–0.74) were significantly less likely to have received CABG. A substance disorder resulted in a 37-fold increased receipt rate of PTCA (OR = 1.37; 95% CI = 1.12–1.68). Receipt of PTCA and CABG was similar among persons with and without MDs, with few exceptions. Future research should include prospective studies using medical record abstraction (none conducted to date) to elucidate reasons on differences in revascularization receipt among some persons with a known MD. Possible reasons for lack of receipt may include the inability to give informed consent, severity of psychosis, or patient refusal.