Severe mental illness and symptoms of acute coronary syndrome in emergency calls

Abstract

Abstract Background It can be lifesaving to act fast and correct when acute life-threatening diseases occur. This is, however, challenging in some patients with severe mental illness as they sometimes experience symptoms differently than patients without severe mental illness. This changed perception can affect the patients’ chances of receiving adequate help, as these patients are already stigmatized even by healthcare personnel. Purpose We aimed to determine whether patients with severe mental illness reported different symptoms of acute coronary syndrome (ACS) in emergency calls than patients without severe mental illness. Methods In this registry-based study, we analyzed symptoms of ACS in emergency calls made from 2014 to 2018 in the Capital Emergency Medical Services, including the Emergency Number (1-1-2) and the Out-of-hours Service (medical helpline). The study population comprised patients with severe mental illness (defined by schizophrenia, bipolar affective disorder, and depression) and a control group of patients without severe mental illness. Additionally, we investigated whether psychotropics (defined by antipsychotics, mood stabilizers, and antidepressants) were associated with altered symptom presentation of ACS. Furthermore, we determined the time from the emergency call to hospitalization. Analyses were performed by logistic regression adjusted for sex and age and t-tests. Results In total, 11,113 emergency calls were included; 917 were from patients with severe mental illness (45.4% were female, average age was 64.6 years), and 10,196 were from patients without severe mental illness (35.3% were female, average age was 67.7 years). Severe mental illness was associated with less frequent chest pain in ACS (odds ratio 0.80, 95%CI: 0.70-0.92, p=0.002). Furthermore, treatment with psychotropics was associated with less frequent chest pain in ACS (odds ratio 0.73, 95%CI: 0.64-0.82, p<0.001). The mean time difference from the emergency call to hospitalization was 17 minutes longer for patients with severe mental illness (1 hour 21 minutes vs. 1 hour 4 minutes, p=0.002) Conclusion Patients with severe mental illness presented less frequent chest pain in ACS in emergency calls than patients without severe mental illness and had increased time to hospitalization. This calls for increased awareness of symptom presentation in patients with severe mental illness to improve the identification and management of ACS.