Focused mental health interventions warranted among patients with MI
Mental health disorders among patients with MI increased in prevalence during a 10-year period, according to results published in the American Journal of Preventive Cardiology.
“The increasing evidence supporting the association of mental health disorders and CVD has prompted the American Heart Association to include major depression and bipolar disorder as moderate-risk conditions associated with accelerated atherosclerosis and early CVD. However, there is a paucity of data on the burden of mental health disorders among patients with acute CVD,” Jayakumar Sreenivasan, MD, MSc, fellow physician in the department of cardiology at Westchester Medical Center, New York College of Medicine, and colleagues wrote. “Understanding ... prevalence of mental health disorders among patients presenting with acute CVD are necessary for health care teams and policymakers to identify vulnerable groups that need attention and formulate appropriate strategies for comprehensive care to simultaneously address mind and body disorders to achieve better outcomes.”
Mental health disorder prevalence
To assess the burden of mental health disorders and outcomes among patients with MI, researchers analyzed 6,117,804 patients (mean age, 67 years; 39% women) hospitalized with MI during a 10-year period to assess trends in mental health disorder prevalence overall, prevalence between various subgroups and coronary revascularization.
Study results showed the most common mental health disorders were major depression (6.2%) and anxiety disorder (6%). Less than 1% of patients had bipolar disorder (0.9%), schizophrenia (0.8%) and PTSD (0.3%).
From 2008 to 2017, prevalence of major depression (4.7% to 7.4%; annual percentage change [APC] = 6.2%; P < .001), anxiety disorders (3.2% to 8.9%; APC = 13.5%; P < .001), PTSD (0.2% to 0.6%; APC = 12.5%; P < .001) and bipolar disorder (0.7% to 1%; APC = 4%; P < .001) increased, whereas schizophrenia prevalence decreased (0.8% to 0.6%; APC = –2.6%). Researchers noted diagnoses of major depression, bipolar disorder and schizophrenia were associated with lower odds of coronary revascularization for acute MI compared with those without any mental health disorders (major depression, adjusted OR = 0.8; 95% CI, 0.72-0.88; bipolar disorder, aOR = 0.69; 95% CI, 0.65-0.72; schizophrenia, aOR = 0.5; 95% CI, 0.47-0.52).
‘A concerning increase’
“Over this 10-year period, there was a concerning increase in the prevalence of most forms of mental health disorders among patients presenting with acute MI ... The increasing burden of mental health disorders among acute MI patients in the U.S. signifies the importance of comprehensive assessment of cardiovascular risk factor profiles,” Cardiology Today Editorial Board Member Erin D. Michos, MD, MHS, FACC, FAHA, FASE, FASPC, associate professor of medicine and associate director of preventive cardiology at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, told Healio. “Acute MI patients with mental health disorders should be provided with comprehensive care for better long-term outcomes ... There are some data to suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health. Simple screening measures can be utilized by health care clinicians for patients with or at risk for cardiovascular disease to assess psychological health status.”