Effect of charted mental illness on reperfusion therapy in hospitalized patients with an acute myocardial infarction in Florida.
Effect of charted mental illness on reperfusion therapy in hospitalized patients with an acute myocardial infarction in Florida.
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佛罗里达州急性心肌梗塞的住院患者患者的精神疾病对再灌注疗法的影响。
DOI：
10.1097/md.0000000000007788
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发表时间：
2017-08
期刊：
影响因子：
1.6
通讯作者：
Zevallos JC
中科院分区：
文献类型：
--
作者：
Campi TR Jr;George S;Villacís D;Ward-Peterson M;Barengo NC;Zevallos JC
与普通人群相比，精神疾病患者携带的危险因素使其易患急性心肌梗死（AMI）导致的心血管死亡率过高。本研究的目的是确定在最近来自佛罗里达的一个样本人群中，与无CMI的AMI患者相比，AMI合并精神疾病（CMI）患者在AMI后接受的再灌注治疗是否更少。使用佛罗里达卫生保健管理局（FL-AHCA）出院登记处对数据进行二次分析。分析纳入了2010年1月1日至2015年12月31日期间因AMI住院的成人。因变量为再灌注治疗（溶栓、经皮冠状动脉介入治疗[PCI]和冠状动脉旁路移植术[CABG]），自变量为是否存在CMI（抑郁症、精神分裂症和双相情感障碍）。多变量逻辑回归模型用于检验控制年龄、性别、种族、人种、健康保险和合并症的相关性。该数据库包括佛罗里达的61，614名AMI住院成人（31.3%为女性）。CMI人群包括1036例患者（1.7%），平均年龄比非CMI患者小5岁（60.2 ±12.8 vs 65.2 ±14.1; P <0.001）。 与无CMI的患者相比，有CMI的患者中女性、政府健康保险持有者和合并症较多的患者比例较高。校正后的比值比表明，与无CMI的患者相比，有CMI的患者接受再灌注治疗的可能性低30%（OR = 0.7; 95%CI = 0.6-0.8）。 在AMI人群中，包括有和没有CMI的人群，女性接受再灌注治疗的可能性比男性低23%;黑人接受再灌注治疗的可能性比白人低26%;持有政府医疗保险的人群接受再灌注治疗的可能性比拥有私人医疗保险的人群低20%至40%。与无CMI的患者相比，AMI和CMI患者接受再灌注治疗的可能性显著降低。这些发现强调了实施AMI管理护理的必要性，旨在减少医学上脆弱的患者（CMI患者、女性、黑人和政府健康保险患者）之间的差异。
Patients with mental illness carry risk factors that predispose them to excess cardiovascular mortality from an acute myocardial infarction (AMI) compared to the general population. The aim of this study was to determine if patients with AMI and charted mental illness (CMI) received less reperfusion therapy following an AMI, compared to AMI patients without CMI in a recent sample population from Florida. A secondary analysis of data was conducted using the Florida Agency for Health Care Administration (FL-AHCA) hospital discharge registry. Adults hospitalized with an AMI from 01/01/2010 to 12/31/2015 were included for the analysis. The dependent variable was administration of reperfusion therapy (thrombolytic, percutaneous coronary intervention [PCI], and coronary artery bypass graft [CABG]), and the independent variable was the presence of CMI (depression, schizophrenia, and bipolar disorder). Multivariate logistic regression models were used to test the association controlling for age, gender, ethnicity, race, health insurance, and comorbidities. The database included 61,614 adults (31.3% women) hospitalized with AMI in Florida. The CMI population comprised of 1036 patients (1.7%) who were on average 5 years younger than non-CMI (60.2 ±12.8 versus 65.2 ±14.1; P < .001). Compared with patients without CMI, patients with CMI had higher proportions of women, governmental health insurance holders, and those with more comorbidities. The adjusted odds ratio indicated that patients with CMI were 30% less likely to receive reperfusion therapy compared with those without CMI (OR = 0.7; 95% CI = 0.6–0.8). Within the AMI population including those with and without CMI, women were 23% less likely to receive therapy than men; blacks were 26% less likely to receive reperfusion therapy than whites; and those holding government health insurances were between 20% and 40% less likely to receive reperfusion therapy than those with private health insurance. Patients with AMI and CMI were statistically significantly less likely to receive reperfusion therapy compared with patients without CMI. These findings highlight the need to implement AMI management care aimed to reduce disparities among medically vulnerable patients (those with CMI, women, blacks, and those with governmental health insurance).