Older persons with coronary heart disease have reduced access to appropriate medical and surgical services if they are also mentally ill. This study determined whether difference exists in access to hospitals that provide on‐site invasive cardiac procedures among a national cohort of edicare acute myocardial infarction () patients with and without comorbid mental illness, and its implications for subsequent procedure use.
Retrospective analyses of edicare claims for initial admissions between anuary and eptember 2007. Hospital service availability was obtained from annual survey data. Logistic regression estimated the associations of mental illness with admission to hospitals with any invasive cardiac services (diagnostic catheterization, coronary angioplasty, or bypass surgery) and post‐admission care patterns and outcomes.
Eighty‐two percent of mentally ill patients ( = 28,888) versus 87 percent of other patients ( = 73,895) were initially admitted to hospitals with invasive cardiac facilities [adjusted odds ratio () = 0.81, < .001]. Admission to such hospitals was associated with overall higher rate of procedure use within 90 days of admission and improved 30‐days readmission and mortality rates. However, irrespective of on‐site service availability of the admitting hospital, mentally ill patients were one half as likely to receive invasive procedures (adjusted approximately 0.5, < .001).
Among Medicare patients with , those with comorbid mental illness were less likely to be admitted to hospitals with on‐site invasive cardiac services. Mental illness was associated with reduced cardiac procedure use within each type of admitting hospitals (with on‐site invasive cardiac services or not).