Poor medical care may be key to explaining a substantial part of the high death rate among patients with mental disorders after myocardial infarction or heart attack, Yale researchers have found.
Published in the June issue of Archives of General Psychiatry, the study used a national sample of 88,241 patients age 65 and older to examine the association between mental disorders, quality of cardiac care and mortality in the first year after hospitalization for heart attack.
"We found that mental disorders are associated with decreased quality of care and a 19% increase in mortality in the year after discharge," said Benjamin Druss, M.D., lead author on the study and assistant professor of psychiatry and in the Department of Epidemiology and Public Health. "The differences in quality appeared to account for a substantial portion of the differences in mortality."
Poor quality care was defined as patients not receiving interventions recommended in guidelines or demonstrated in randomized trials to reduce mortality. These include prescriptions for ACE inhibitors, aspirin and beta-blockers at discharge, smoking cessation counseling and revascularization using "clot buster" drugs immediately after a heart attack.
"Clinicians and researchers have long known that patients with serious mental disorders such as schizophrenia and major depression have elevated death rates, but they've never been able to adequately explain why," said Druss. "They have often assumed that biological factors such as stress and hormone imbalances put these patients at elevated risk."
Druss said the current study suggests that poor quality of medical care may be an important reason that these patients die younger than the general population. "The primary factors contributing to this poor quality are not presently understood," Druss said. "It is not clear whether the poor quality is mainly a result of patients' fears or difficulty complying, or providers' discomfort in treating these patients. Whichever the source, the study's findings imply that improving quality of medical care may be an important step in reducing these patients' excess mortality."
Other authors on the study included W. David Bradford, Robert Rosenheck, M.D., Martha J. Radford, M.D., and Harlan Krumholz, M.D.
The study was funded by grants from the National Institutes of Mental Health and the National Association for Research in Schizophrenia and Affective Disorders.
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