Mental health conditions linked to inequalities in heart attack care

The research investigated whether people with schizophrenia, bipolar disorder or depression receive the same quality of care following a heart attack as people without these conditions.

Researchers from the University of Edinburgh, University of Glasgow, King’s College London and Health Data Research UK were involved in the study, which analysed data from more than 210,000 people admitted to hospital with a heart attack in England between 2019 and 2023. The linked data was made available to the researchers by the British Heart Foundation Data Science Centre’s CVD-COVID-UK/COVID IMPACT research programme.

People with mental health conditions tend to have shorter life expectancies than the wider population, with higher rates of heart disease contributing to this difference.

Differences in care

The researchers examined the care received following two types of heart attack: NSTEMI, where an artery is partially blocked, and STEMI, where an artery is completely blocked.

They looked at whether patients received guideline-recommended care, including diagnostic tests, treatments to reopen blocked arteries, admission to specialist cardiac wards and referral to cardiac rehabilitation programmes.

Following an NSTEMI heart attack, people with mental health conditions were less likely to receive angiography – a key test used to check for blockages in the heart's arteries.

They were also less likely to be admitted to specialist cardiac wards, where patients have access to dedicated heart doctors and nurses, and less likely to be referred to cardiac rehabilitation programmes to support their recovery.

Following a STEMI heart attack, people with schizophrenia were less likely to be referred for cardiac rehabilitation and to receive medication to help prevent another heart attack.

Impact of the pandemic

The researchers also investigated whether the COVID-19 pandemic had widened inequalities in heart attack care.

Although the number of people admitted to hospital with heart attacks fluctuated during the pandemic, the study found that the pandemic did not appear to worsen existing inequalities in care between people with and without mental health conditions.

Improving access to care

The findings suggest that people with mental health conditions continue to experience inequalities in access to recommended healthcare following a heart attack.

The researchers say disparities in care associated with mental health conditions should be routinely monitored as part of national heart disease audits.

They also call for improved access to mental health care within general hospitals and tailored cardiac rehabilitation pathways to help ensure that people with mental health conditions receive appropriate care following a heart attack.

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Further information

Read the full BMJ Open paper