"We found minimal differences in both the process and outcomes of care for this sample of VA patients," said lead author Laura A. Petersen, MD, MPH, of VA's Houston Center for Quality of Care and Utilization Studies and Baylor College of Medicine. She said part of the reason for the findings may be VA's experience overall in caring for veterans with mental illness. She also cited the integration of mental health care with general medical care at VA's nationwide network of sites, which share quality standards, electronic patient records and administrative leadership.
Petersen and colleagues from Yale and Harvard analyzed the records of 4,340 patients who received care for heart attack at 81 VA hospitals in 1994 and 1995. Of these, about 20 percent had received a diagnosis of schizophrenia, depression or other mental illness, or been treated for substance abuse.
Patients in both groups--excluding those with medical contraindications--were equally likely to receive medications shown to increase survival after heart attack: clot-busting drugs, beta blockers, angiotensin converting enzyme inhibitors, and aspirin. Patients in both groups who received diagnostic angiography--X-rays of the heart or blood vessels--were equally likely to receive angioplasty or coronary artery bypass surgery, both treatments for restoring blood flow to the heart.
However there was a slightly lower rate of diagnostic angiography among the mentally ill, both during their initial hospital stay at VA and within 90 days of follow up, either at VA hospitals or private hospitals that accept Medicare. Also, while both groups had equal survival rates for 90 days after the heart attack, patients with mental illness may have been more likely to die within the year--although this finding did not reach statistical significance.
Petersen said these findings are not surprising in light of previous research on the health outcomes of psychiatric patients, who may have increased socioeconomic burdens, fear of medical procedures, or other factors that interfere with their care.
"We know from other studies that patients with mental illness have a higher mortality," said Petersen. There is a complex web of factors that may contribute to this. Several studies, for example, have suggested a link between depression and heart attack mortality, possibly due in part to physiological effects of depression on the heart.
Collaborating with Petersen on the study were Sharon-Lise T. Normand, PhD, of Harvard Medical School; Benjamin G. Druss, MD, MPH, of Emory University, formerly with VA and Yale University; and Robert A. Rosenheck, MD, of the VA Connecticut Healthcare System and Yale University. The study was funded by VA.
NOTE FOR REPORTERS: Dr. Laura A. Petersen, is the lead author for this study. For interviews, please contact Matt Price, VA Houston Center for Quality of Care and Utilization Studies, at 713-794-8616 or mattp@bcm.tcm.edu.
Journal
Health Services Research