After having heart attacks, patients with mental illnesses are significantly less likely to undergo cardiovascular procedures than patients without mental disorders, Yale researchers say.

"Having a mental disorder reduces a patient's chances of receiving cardiovascular procedures by up to 32%," says Dr. Benjamin Druss, assistant professor of psychiatry and epidemiology and public health at the School of Medicine.

"This difference in care was not based on the severity of cardiac illness, or hospital or regional differences between groups," he adds

Published in the Jan. 26 issue of Journal of The American Medical Association, the study looked at a sample of 113,653 patients who had myocardial infarction. Of those, 5,653 were mentally ill.

Druss and his team found that patients with mental disorders were 25% less likely to receive angioplasty procedures, 32% less likely to undergo coronary bypass surgery and 28% less likely to undergo cardiac catheterization than those without mental disorders.

Whatever the reasons, Druss says, the fact that these differences could not be explained by measured clinical factors was cause for concern.

"Patients with mental disorders are a vulnerable population who may be susceptible to inadequate medical care," Druss says. "Further work is needed to better understand factors leading to these differences and their implications for quality and long-term outcomes of their cardiac care."

A number of studies have found race- and sex-based differences in rates of cardiovascular procedures in the United States, but no previous studies have examined this issue for patients with mental disorders.

Druss' team members at Yale included David W. Bradford, Dr. Robert A. Rosenheck, Dr. Martha J. Radford and Dr. Harlan M. Krumholz.

-- By Karen Peart

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