Mental ill-health and hospital care for heart attack v1
Research type
Research Study
Full title
Severe mental illness and receipt of acute cardiac care and mortality following myocardial infarction
IRAS ID
314045
Contact name
Caroline Jackson
Contact email
Sponsor organisation
University of Edinburgh
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 7 months, 30 days
Research summary
Summary of Research
Severe mental illness (SMI), which includes conditions such as schizophrenia, bipolar disorder and major depression, affects about one in ten people. People with SMI die 10-20 years sooner than the general population. This is mainly due to poorer physical health, in particular a higher risk of cardiovascular disease (CVD), which includes conditions such as heart attack. After a heart attack, people with SMI are more likely to die than those without SMI. The reasons for this are not well understood, but differences in delivery of clinical care may contribute. We also do not know whether any differences in delivery of care and risk of dying after a heart attack have been affected by the COVID-19 pandemic. In this project, we will use data from electronic patient records to study links between SMI and (1) care provided in hospitals after a heart attack and (2) death following a heart attack and (3) whether these have been affected by the COVID-19 pandemic. To help us to understand our findings from this work and to provide insight into experiences of the care pathway we will interview patients with SMI who have had a heart attack and a family member/carer, as well as relevant health care workers involved with hospital care for patients with a heart attack. Our project will identify points in the care pathway where patients with SMI may be disadvantaged and/or where healthcare workers could be better supported to deliver the best possible care for these vulnerable patients.Summary of Results
: Our study aimed to investigate how receipt of hospital care for a heart attack differed in people with compared to without mental illness and whether any differences in care were affected by the COVID-19 pandemic. The study had two parts. We used data from electronic patient records to determine whether receipt of clinical guideline-indicated care following a heart attack and likelihood of death following a heart attack differs by pre-existing mental illness status. We also examined whether differences in receipt of care were affected by the COVID 19 pandemic. To help us understand our findings from this work and to provide insight into experiences of the care pathway we also interviewed patients with mental illness who had experienced a heart attack and relevant health care workers involved with hospital care for patients with a heart attack. Among patients with a non-ST elevation myocardial infarction (a type of heart attack that usually affects a non-major blood vessel), those with a pre-existing mental illness were less likely to receive most of the clinical guideline indicated care standards. Among patients with a ST elevation myocardial infarction (a type of heart attack that affects a major blood vessel), there was no clear differences in receipt of care standards, such as timely procedures to unblock arteries. Differences in receipt of heart attack care were not affected by the COVID 19 pandemic. Following a heart attack, risk of death at 30 days and 1 year was higher in those with versus without each mental illness.
Interviews with 13 health care professionals and 8 people with mental illness who had experienced a heart attack provided a number of insights. Patients’ experiences were mixed, with identified areas of concern including, for example, how well they were listened to by staff; quality of communication; and trust. Health care professionals identified practitioner-related, patient-related and system barriers when trying to deliver optimal care to this patient group, such as: stigma (negative attitudes/stereotypes) towards patients with mental illness; lack of experience or confidence in caring for patients with mental illness; concerns about patient post-operative medication compliance; challenging behaviour of some patients; mental health training deficits; workforce shortfalls and workload intensity. Examples of good practice included: personalisation and increased high quality communication; adaptations to and tailoring of the patient’s environment whilst in hospital; and consultant pre-operative visits. These have implications for steps to improved care for this vulnerable group of patients.REC name
West of Scotland REC 1
REC reference
22/WS/0141
Date of REC Opinion
24 Nov 2022
REC opinion
Further Information Favourable Opinion