title: Alcohol and drug use disorders among patients with myocardial infarction: associations with disparities in care and mortality.
abstract: BACKGROUND
  Because alcohol and drug use disorders (SUDs) can influence quality of care, we compared patients with and without SUDs on frequency of catheterization, revascularization, and in-hospital mortality after acute myocardial infarction (AMI).
  
  
  METHODS
  This study employed hospital discharge data identifying all adult AMI admissions (ICD-9-CM code 410) between April 1996 and December 2001. Patients were classified as having an SUD if they had alcohol and/or drug (not nicotine) abuse or dependence using a validated ICD-9-CM coding definition. Catheterization and revascularization data were obtained by linkage with a clinically-detailed cardiac registry. Analyses (controlling for comorbidities and disease severity) compared patients with and without SUDs for post-MI catheterization, revascularization, and in-hospital mortality.
  
  
  RESULTS
  Of 7,876 AMI unique patient admissions, 2.6% had an SUD. In adjusted analyses mortality was significantly higher among those with an SUD (odds ratio (OR) 2.02; 95%CI: 1.10-3.69), while there was a trend toward lower catheterization rates among those with an SUD (OR 0.75; 95%CI: 0.55-1.01). Among the subset of AMI admissions who underwent catheterization, the adjusted hazard ratio for one-year revascularization was 0.85 (95%CI: 0.65-1.11) with an SUD compared to without.
  
  
  CONCLUSIONS
  Alcohol and drug use disorders are associated with significantly higher in-hospital mortality following AMI in adults of all ages, and may also be associated with decreased access to catheterization and revascularization. This higher mortality in the face of poorer access to procedures suggests that these individuals may be under-treated following AMI. Targeted efforts are required to explore the interplay of patient and provider factors that underlie this finding.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada ; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada ; Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Beck
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Southern
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000368:Aged; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models
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