Patients with acute myocardial infarction may have worse outcomes if they also have a history of depression. The early management of acute myocardial infarction is known to influence outcomes, and patients with a coexisting history of depression may be treated differently in the emergency department than those without one. Our goal was to determine whether having a charted history of depression was associated with a lower-priority emergency department triage score and worse performance on quality-of-care indices.
We conducted a retrospective population-based cohort analysis involving patients with acute myocardial infarction admitted to 96 acute care hospitals in the province of Ontario from April 2004 to March 2005. We calculated the adjusted odds of low-priority triage (Canadian Emergency Department Triage and Acuity Scale score of 3, 4 or 5) for patients with acute myocardial infarction who had a charted history of depression. We compared these odds with those for patients having a charted history of asthma or chronic obstructive pulmonary disease (COPD). Secondary outcome measures were the odds of meeting benchmark door-to-electrocardiogram, door-to-needle and door-to-balloon times.
Of 6784 patients with acute myocardial infarction, 680 (10.0%) had a past medical history of depression documented in their chart. Of these patients, 39.1% (95% confidence interval [CI] 35.3%-42.9%) were assigned a low-priority triage score, as compared with 32.7% (95% CI 31.5%-33.9%) of those without a charted history of depression. The adjusted odds of receiving a low-priority triage score with a charted history of depression were 1.26 (p = 0.01) versus 0.88 (p = 0.23) with asthma and 1.12 (p = 0.24) with COPD. For patients with a charted history of depression, the median door-to-electrocardiogram time was 20.0 minutes (v. 17.0 min for the rest of the cohort), median door-to-needle time was 53.0 (v. 37.0) minutes, and median door-to-balloon time was 251.0 (v. 110.0) minutes. The adjusted odds of missing the benchmark time with a charted history of depression were 1.39 (p
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Cites: JAMA. 2000 Jun 28;283(24):3223-910866870
Cites: JAMA. 2000 Jan 26;283(4):506-1110659877
Cites: Circulation. 2000 Oct 10;102(15):1773-911023931
Cites: Arch Gen Psychiatry. 2001 Jun;58(6):565-7211386985
Cites: Am J Cardiol. 2001 Aug 15;88(4):337-4111545750
Cites: Am J Epidemiol. 2003 Aug 1;158(3):280-712882951
Cites: Arch Intern Med. 2003 Oct 27;163(19):2345-5314581255
Cites: Circulation. 2004 Mar 16;109(10):1223-515007008
Cites: Circulation. 2004 Aug 3;110(5):588-63615289388
Cites: JAMA. 1993 Oct 20;270(15):1819-258411525
Cites: Lancet. 1994 Feb 5;343(8893):311-227905143
Cites: Circulation. 1995 Mar 15;91(6):1659-687882472
Cites: J Am Coll Cardiol. 2000 Sep;36(3):959-6910987628
Cites: Arch Intern Med. 2000 May 8;160(9):1261-810809028