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Mental Illness, Access to Hospitals with Invasive Cardiac Services, and Receipt of Cardiac Procedures by Medicare Acute Myocardial Infarction Patients
Author(s) -
Li Yue,
Glance Laurent G.,
Lyness Jeffrey M.,
Cram Peter,
Cai Xueya,
Mukamel Dana B.
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12010
Subject(s) - medicine , myocardial infarction , emergency medicine , mental illness , odds ratio , cohort , logistic regression , retrospective cohort study , coronary artery disease , intensive care medicine , mental health , psychiatry
Objective Older persons with coronary heart disease have reduced access to appropriate medical and surgical services if they are also mentally ill. This study determined whether difference exists in access to hospitals that provide on‐site invasive cardiac procedures among a national cohort of M edicare acute myocardial infarction ( AMI ) patients with and without comorbid mental illness, and its implications for subsequent procedure use. Methods Retrospective analyses of M edicare claims for initial AMI admissions between J anuary and S eptember 2007. Hospital service availability was obtained from annual survey data. Logistic regression estimated the associations of mental illness with admission to hospitals with any invasive cardiac services (diagnostic catheterization, coronary angioplasty, or bypass surgery) and post‐admission care patterns and outcomes. Results Eighty‐two percent of mentally ill AMI patients ( n = 28,888) versus 87 percent of other AMI patients ( n = 73,895) were initially admitted to hospitals with invasive cardiac facilities [adjusted odds ratio ( OR ) = 0.81, p < .001]. Admission to such hospitals was associated with overall higher rate of procedure use within 90 days of admission and improved 30‐days readmission and mortality rates. However, irrespective of on‐site service availability of the admitting hospital, mentally ill patients were one half as likely to receive invasive procedures (adjusted OR approximately 0.5, p < .001). Conclusions Among Medicare patients with AMI , those with comorbid mental illness were less likely to be admitted to hospitals with on‐site invasive cardiac services. Mental illness was associated with reduced cardiac procedure use within each type of admitting hospitals (with on‐site invasive cardiac services or not).