A cohort study was conducted to determine trends and impact on outcomes of acute myocardial infarction (AMI) in patients with pre-existing psychosis. While post-AMI psychosis has been extensively studied, contemporary studies including temporal trends on impact of pre-AMI Psychosis on AMI and post-AMI outcomes are lacking. This study used Nationwide Inpatient Sample from 2002 to 2012. AMI and psychosis as primary and secondary diagnosis respectively were detected using validated ICD-9-CM codes, and Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).
A total of 7,174,274 AMI hospital admissions from 2002 to 2012 were analyzed of which 1.77% had psychosis. Proportion of hospitalizations with psychosis increased from 6.94% to 11.85% (P-trend < 0.001). Utilization of percutaneous coronary intervention (PCI) was lower in patients with psychosis (29.98% vs. 40.36%, P < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with psychosis (8.01% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with psychosis (aOR 0.677; 95% CI 0.630–0.727; P < 0.001) but discharge to specialty care higher (aOR 1.870; 95%CI 1.786–1.958; P < 0.001). In addition, median length of hospitalization (3.77 vs. 2.90 days; P < 0.001) was higher in hospitalizations with psychosis.
This study displayed increasing proportion of patients with psychosis admitted due to AMI in last decade with lower mortality but higher morbidity post-infarction, and significantly less utilization of PCI and CABG. There was also increased length of stay patients with MDD. There is need to explore reasons behind this disparity in outcomes and PCI and CABG utilization to improve post-AMI outcomes in this vulnerable population.
by Dr. Zeeshan Mansuri MD MPH
Psychiatry Resident, Texas Tech University Health Science Center (Midland, TX)