Mental health disorders among patients with acute myocardial infarction in the United States.

OBJECTIVE

To assess the prevalence, temporal trends and sex- and racial/ethnic differences in the burden of mental health disorders (MHD) and outcomes among patients with myocardial infarction (MI) in the United States.

METHODS

Using the National Inpatient Sample Database, we evaluated a contemporary cohort of patients hospitalized for acute MI in the United States over 10 years period from 2008 to 2017. We used multivariable logistic regression analysis for in-hospital outcomes, yearly trends and estimated annual percent change (APC) in odds of MHD among MI patients.

RESULTS

We included a total sample of 6,117,804 hospitalizations for MI (ST elevation MI in 30.4%), with a mean age of 67.2 ​± ​0.04 years and 39% females. Major depression (6.2%) and anxiety disorders (6.0%) were the most common MHD, followed by bipolar disorder (0.9%), schizophrenia/psychotic disorders (0.8%) and post-traumatic stress disorder (PTSD) (0.3%). Between 2008 and 2017, the prevalences significantly increased for major depression (4.7%-7.4%, APC +6.2%, p ​< ​.001), anxiety disorders (3.2%-8.9%, APC +13.5%, p ​< ​.001), PTSD (0.2%-0.6%, +12.5%, p ​< ​.001) and bipolar disorder (0.7%-1.0%, APC +4.0%, p ​< ​.001). Significant sex- and racial/ethnic-differences were also noted. Major depression, bipolar disorder or schizophrenia/psychotic disorders were associated with a lower likelihood of coronary revascularization.

CONCLUSION

MHD are common among patients with acute MI and there was a concerning increase in the prevalence of major depression, bipolar disorder, anxiety disorders and PTSD over this 10-year period. Focused mental health interventions are warranted to address the increasing burden of comorbid MHD among acute MI.