Background:
Mental and behavioral health disorders (MBD) are associated with an increased risk of cardiovascular disease and with worse long-term outcomes after myocardial infarction (MI).
Hypothesis:
We hypothesized the prevalence of MBD among patients with acute MI is rising over time.
Methods:
Using National Inpatient Sample Database, we assessed temporal trends in the prevalence of MBD and in-hospital outcomes among patients hospitalized for acute MI in the US from 2008-2017. We used multiple logistic regression for in-hospital outcomes and examined yearly trends and estimated annual percent change (APC) in odds of MBD among MI patients.
Results:
We included a total of 6,117,804 patients with MI (ST elevation MI 30.4%) with a mean age of 67.2±0.04 and 39% females. Psychoactive substance use disorder (PSD) (24.9%) was the most common behavioral health disorder, and major depression (6.2%) and anxiety disorders (6.0%) were the most common mental health disorders, followed by bipolar disorder (0.9%), schizophrenia/psychotic disorders (0.8%) and post-traumatic stress disorder (PTSD) (0.3%). Between 2008 to 2018, the prevalence of PSD (23.7-25.0%, APC +0.6%), major depression (4.7-7.4%, APC +6.2%), anxiety disorders (3.2-8.9%, APC +13.5%), PTSD (0.2-0.6%, +12.5%) and bipolar disorder (0.7-1.0%, APC +4.0%) significantly increased over the time period. Major depression, bipolar disorder or schizophrenia/psychotic disorders were associated with a lower likelihood of coronary revascularization, although a co-diagnosis of MBD was associated with a lower risk of in-hospital mortality.
Conclusion:
MBD are common among patients with acute MI and there was a concerning increase in the prevalence of PSD, major depression, bipolar disorder, anxiety disorders and PTSD. Focused mental and behavioral health interventions and health care policy changes are warranted to address the increasing burden of comorbid MBD among acute MI.