Disparities in cardiovascular outcomes among emergency department patients with mental illness.
Disparities in cardiovascular outcomes among emergency department patients with mental illness.
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DOI：
10.1016/j.ajem.2022.02.037
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发表时间：
2022-05
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--
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中科院分区：
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与无精神疾病的患者相比，精神疾病患者接受的护理质量较低，心血管（CV）结局较差。本研究探讨了急诊科（艾德）胸痛就诊后心血管结局的心理健康相关差异。该回顾性队列包括华盛顿州的成年医疗补助受益人，他们在2010-2017年从艾德出院，主要诊断为未指明的胸痛。将患有任何精神疾病（在索引艾德访视1年内的任何精神健康诊断或精神健康特定服务使用）和严重精神疾病（在索引艾德访视1年内至少两次索赔（在不同的服务日期），诊断为精神分裂症、其他精神病性障碍或主要心境障碍）的患者的结局与无精神疾病的患者进行比较。我们关注的结局是艾德访视出院后30天和6个月内主要不良心脏事件（MACE）的发生率，定义为死亡、急性心肌梗死（AMI）、CV再住院或血运重建的复合事件。次要结局包括艾德出院后30天内的心血管诊断测试（诊断性血管造影、负荷试验、超声心动图和冠状动脉计算机断层扫描（CT）血管造影）率。结局评估仅纳入治疗和出院访视。分层逻辑随机效应回归模型评估了精神疾病与关注结果之间的关联，控制了年龄，性别，种族，民族，Elixhauser合并症和过去一年的医疗保健使用以及固定年效应。在我们的数据集中有98，812次治疗和释放艾德访视。在30天时，患有任何精神疾病的入组者在MACE（AOR 0.96; 95% CI，0.72-1.27）或任何单个组分的发生率方面没有差异。在6个月时，患有任何精神疾病（AOR 1.86; 95% CI，1.11-3.09）和严重精神疾病（AOR 2.60; 95% CI 1.33-5.13）的入组者因CV疾病住院的可能性显著高于无精神疾病的入组者。患有任何精神疾病的个体在30天内的检测率较高（AOR 1.16; 95% CI 1.07-1.27）。精神疾病患者的MACE发生率相似，但在艾德胸痛访视后，某些CV结局（如CV住院和诊断性检测）的发生率较高。
Patients with mental illness have been shown to receive lower quality of care and experience worse cardiovascular (CV) outcomes compared to those without mental illness. This present study examined mental health-related disparities in CV outcomes after an Emergency Department (ED) visit for chest pain. This retrospective cohort included adult Medicaid beneficiaries in Washington state discharged from the ED with a primary diagnosis of unspecified chest pain in 2010-2017. Outcomes for patients with any mental illness (any mental health diagnosis or mental-health specific service use within 1 year of an index ED visit) and serious mental illness (at least two claims (on different dates of service) within 1 year of an index ED visit with a diagnosis of schizophrenia, other psychotic disorder, or major mood disorder) were compared to those of patients without mental illness. Our outcomes of interest were the incidence of major adverse cardiac events (MACE) within 30 days and 6 months of discharge of their ED visit, defined as a composite of death, acute myocardial infarction (AMI), CV rehospitalization, or revascularization. Secondary outcomes included cardiovascular diagnostic testing (diagnostic angiography, stress testing, echocardiography, and coronary computed tomography (CT) angiography) rates within 30 days of ED discharge. Only treat-and-release visits were included for outcomes assessment. Hierarchical logistic random effects regression models assessed the association between mental illness and the outcomes of interest, controlling for age, gender, race, ethnicity, Elixhauser comorbidities, and health care use in the past year, as well as fixed year effects. There were 98,812 treat-and-release ED visits in our dataset. At 30 days, enrollees with any mental illness had no differences in rates of MACE (AOR 0.96; 95% CI, 0.72-1.27) or any of the individual components. At 6 months, enrollees with any mental illness (AOR 1.86; 95% CI, 1.11-3.09) and serious mental illness (AOR 2.60; 95% CI 1.33-5.13) were significantly more likely to be hospitalized for a CV condition compared to those without mental illness. Individuals with any mental illness had higher rates of testing at 30 days (AOR 1.16; 95% CI 1.07-1.27). Patients with mental illness have similar rates of MACE, but higher rates of certain CV outcomes, such as CV hospitalization and diagnostic testing, after an ED visit for chest pain.
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影响因子：
2.3
作者：
Adibelli，Derya;Ozkan，Ilknur
通讯作者：
Ozkan，Ilknur
影响因子：
37.8
作者：
Mahler, Simon A.;Lenoir, Kristin M.;Miller, Chadwick D.
通讯作者：
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影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
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影响因子：
1.6
作者：
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通讯作者：
Zevallos JC
影响因子：
--
作者：
Druss, BG;Bradford, WD;Krumholz, HM
通讯作者：
Krumholz, HM