title: Mental illness, access to hospitals with invasive cardiac services, and receipt of cardiac procedures by Medicare acute myocardial infarction patients.
abstract: OBJECTIVE
  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 Medicare acute myocardial infarction (AMI) patients with and without comorbid mental illness, and its implications for subsequent procedure use.
  
  
  METHODS
  Retrospective analyses of Medicare claims for initial AMI admissions between January and September 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.
  
  
  RESULTS
  Eighty-two percent of mentally ill AMI patients (n = 28,888) versus 87 percent of other AMI patients (n = 73,895) were initially admitted to hospitals with invasive cardiac facilities [adjusted odds ratio (OR) = 0.81, p < .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 OR approximately 0.5, p < .001).
  
  
  CONCLUSIONS
  Among Medicare patients with AMI, 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).
authors.affiliation: Department of Community and Preventive Medicine, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lyness
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006739:Hospital Administration / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology*; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States