Campi Thomas R, George Sharon, Villacís Diego, Ward-Peterson Melissa, Barengo Noël C, Zevallos Juan C
American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda Universidad de las Américas, Facultad de Medicina, Quito, Ecuador Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
Medicine (Baltimore). 2017 Aug;96(34):e7788. doi: 10.1097/MD.0000000000007788.
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).
与普通人群相比，患有精神疾病的患者存在一些风险因素，使他们更容易因急性心肌梗死（AMI）而出现心血管疾病超额死亡率。本研究的目的是确定在佛罗里达州最近的样本人群中，患有AMI且有记录在案的精神疾病（CMI）的患者与没有CMI的AMI患者相比，在发生AMI后接受再灌注治疗的情况是否更少。
使用佛罗里达州医疗保健管理局（FL-AHCA）的医院出院登记处数据进行了数据二次分析。纳入分析的是2010年1月1日至2015年12月31日因AMI住院的成年人。因变量是再灌注治疗的实施情况（溶栓、经皮冠状动脉介入治疗[PCI]和冠状动脉旁路移植术[CABG]），自变量是CMI的存在情况（抑郁症、精神分裂症和双相情感障碍）。使用多变量逻辑回归模型来检验在控制年龄、性别、种族、民族、健康保险和合并症的情况下的关联。
该数据库包括佛罗里达州61614名因AMI住院的成年人（31.3%为女性）。CMI人群包括1036名患者（1.7%），他们的平均年龄比非CMI患者小5岁（60.2±12.8岁对65.2±14.1岁；P<.001）。与没有CMI的患者相比，患有CMI的患者中女性、政府医疗保险持有者以及合并症更多的患者比例更高。调整后的比值比表明，患有CMI的患者接受再灌注治疗的可能性比没有CMI的患者低30%（OR = 0.7；95%CI = 0.6 - 0.8）。在包括有CMI和无CMI的AMI人群中，女性接受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接受再灌注治疗的可能性比拥有私人医疗保险的人低20%至40%。
与没有CMI的患者相比，患有AMI和CMI的患者接受再灌注治疗的可能性在统计学上显著更低。这些发现凸显了实施旨在减少医疗弱势群体（患有CMI的患者、女性、黑人以及持有政府医疗保险的人）之间差异的AMI管理护理的必要性。
