{
  "abstract": "Background People with severe mental illness (SMI) have a life expectancy that is reduced by 10–25 years and are 4 times more likely to die prematurely from cardiovascular disease (CVD), compared to those without SMI. Although excess cardiovascular risk factors have been reported in those with SMI, research into outcomes following myocardial infarction (MI) for patients with SMI is limited, which this study seeks to address.Methods This cohort study analysed 1.8 million index MI records from the United States Nationwide Readmissions Database (NRD; 2016 to 2022). All-cause in-hospital mortality and 30-day readmission for SMI vs non-SMI patients were investigated using logistic regression and flexible parametric survival models, respectively. ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) were analysed separately given their different treatment pathways and associated risks. All models were adjusted for age, sex, deprivation and year of MI.Results Between 2016 and 2022, there were 1,847,469 admissions for index MI, of which 33,957 (1.8%) described a history of SMI. Those with SMI were younger (mean age 60 (SD=12.6) vs. 67 (SD=13.5)), more likely to be female (46.2% (n=15,685) vs. 37.8% (n=686,083)), and lived in more deprived areas (37.4% (n=12,482) vs. 28.5% (n=509,939) in the lowest income quartile) than those without SMI.Patients with SMI had an increased risk of in-hospital mortality for STEMI and NSTEMI (adjusted odds ratio [aOR] 1.37 [95% CI 1.26–1.47] and 1.09 [1.01–1.18] respectively) compared with individuals without SMI. By SMI subgroup, there was an increased risk of death for individuals with schizophrenia with STEMI and NSTEMI (aOR 2.5 [95% CI 2.19–2.86] and 1.27 [1.10–1.45] respectively) and for patients with other psychosis with NSTEMI (aOR 1.18 [95% CI 1.00–1.38]).Readmission within 30 days was more likely for those with SMI than without (adjusted hazard ratio aHR 1.78 [95% CI 1.67–1.89] and 1.64 [1.59–1.69] for STEMI and NSTEMI respectively) which was consistent by SMI subgroup (aHR 1.96 [95% CI 1.73–2.22] and 1.74 [1.64–1.85] for schizophrenia; aHR 1.67 [1.55 – 1.81] and 1.56 [1.50 – 1.63] for bipolar disorder and aHR 1.99 [1.71- 2.30] and 1.75 [1.63 -1.88] for other psychosis for STEMI and NSTEMI respectively).Conclusion Those with severe mental illness experiencing their first myocardial infarction are more likely to die during hospitalisation and are more likely to be readmitted to hospital within 30-days following discharge. Further research is needed to investigate reasons for this, which may include delayed diagnosis and reduced access to first-line recommended treatment.",
  "authors": [
    {
      "affiliations": [
        "Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK",
        "Leeds Institute for Data Analytics, University of Leeds, Leeds, UK"
      ],
      "name": "Eleanor H Booth"
    },
    {
      "affiliations": [
        "Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK",
        "Leeds Institute for Data Analytics, University of Leeds, Leeds, UK"
      ],
      "name": "Jonathon A Batty"
    },
    {
      "affiliations": [
        "Institute of Health Informatics, University College London, London, UK"
      ],
      "name": "Johan H Thygesen"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "Max Henderson"
    },
    {
      "affiliations": [
        "Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK",
        "Leeds Institute for Data Analytics, University of Leeds, Leeds, UK"
      ],
      "name": "Marlous Hall"
    }
  ],
  "title": "P20 The impact of severe mental illness on outcomes following myocardial infarction: a large-scale retrospective cohort study of United States hospital admissions",
  "uid": "794fe19c-3cfa-5c71-a1db-d58dc72571fd"
}