Mental disorders, mortality following myocardial infarction and the impact of the COVID-19 pandemic in England: a cohort study

Background and AimsPeople with schizophrenia experience poorer cardiovascular disease (CVD) outcomes, but other mental disorders have been little studied. We compared post-myocardial infarction (MI) mortality by mental disorder, explored whether differences in care contributed to mortality disparities, and investigated whether disparities worsened during the COVID-19 pandemic. MethodsWe identified people with MI in England (November 2019 - February 2023) from the Myocardial Ischaemia National Audit Programme, ascertaining mental disorder diagnoses from linked electronic health records and mortality from national death records. We used logistic regression to compare 30-day and one-year mortality between people with each of schizophrenia, bipolar disorder or depression (of any severity) versus those without these disorders for ST-elevation MI (STEMI) and non-STEMI (NSTEMI), adjusting for confounders and investigating differences by calendar time period. For one-year mortality, we additionally adjusted for receipt of guideline-informed care. ResultsWe included 131,075 patients with NSTEMI and 79,045 with STEMI. For NSTEMI, schizophrenia [odds ratio (OR) 1.73, 95% CI 1.20-2.49] and depression (1.17, 1.08-1.26) were associated with higher 30-day mortality. For STEMI, 30-day mortality was higher in people with schizophrenia (1.61, 1.09-2.37), bipolar disorder (1.68, 1.08-2.59) and depression (1.10, 1.01-1.20). All disorders were associated with higher one-year mortality following NSTEMI and STEMI, with adjustment for care attenuating estimates. Associations were generally unaffected by the COVID-19 pandemic. ConclusionsOur findings highlight the increased risk of post-MI mortality in people with mental disorders and support the urgent need to improve implementation of acute cardiac care standards in this group. SummaryWe used linked electronic health records from over 200 000 NSTEMI and STEMI patients in England to compare mortality following myocardial infarction by mental disorder status, evaluate whether differences in receipt of acute MI care by mental disorder might help to explain any disparities in mortality, and assess how any disparities in mortality changed following the COVID-19 pandemic. We identified mortality disparities for both NSTEMI and STEMI, which were greatest for people with schizophrenia, but also evident for bipolar disorder and depression. Our findings suggest that differences in receipt of care contributed to poorer survival at one year. Disparities were generally unaffected by the COVID-19 pandemic.