---
title: "Post-MI mortality by mental disorder in England: impact of care differences and the COVID-19 pande"
id: "pubmed-41843746"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41843746"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41843746/"
doi: "10.1093/ehjqcco/qcag044"
published_at: "2026-08-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Post-MI mortality by mental disorder in England: impact of care differences and the COVID-19 pande
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41843746
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41843746/)
- **DOI:** [10.1093/ehjqcco/qcag044](https://doi.org/10.1093%2Fehjqcco%2Fqcag044)
- **Published At:** 2026-08-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This cohort study used linked national datasets in England to compare post-myocardial infarction (**MI**) mortality by diagnosed mental disorders, including **schizophrenia**, **bipolar disorder**, and **depression**. - The study population comprised patients with NSTEMI (131,075) and STEMI (79,045) identified from the Myocardial Ischaemia National Audit Programme between November 2019 and February 2023. - Mental disorder diagnoses were ascertained from linked electronic health records and deaths from national death records. - Analyses compared 30-day and one-year mortality for each disorder versus no disorder, stratified by STEMI and NSTEMI, adjusting for confounders; one-year models also adjusted for receipt of guideline-informed care. - For NSTEMI, schizophrenia (OR 1.73, 95% CI 1.20–2.49) and depression (OR 1.17, 95% CI 1.08–1.26) were associated with higher 30-day mortality. - For STEMI, 30-day mortality was higher with schizophrenia (OR 1.61, 95% CI 1.09–2.37), bipolar disorder (OR 1.68, 95% CI 1.08–2.59), and depression (OR 1.10, 95% CI 1.01–1.20). - All three disorders were associated with increased one-year mortality after both NSTEMI and STEMI; adjustment for guideline-informed care attenuated these associations, suggesting care differences contribute to disparities. - Relative mortality disparities were generally unchanged during the **COVID-19 pandemic** time periods studied. - Authors conclude that people with mental disorders face higher post-MI mortality and that improved implementation of acute cardiac care standards may reduce this gap.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/41843746/#linkout) Title & authors Abstract Plain language summary Conflict of interest statement Comment in Similar articles MeSH terms Related information Grants and funding LinkOut - more resources Eur Heart J Qual Care Clin Outcomes Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41843746/) . 2026 Aug 11;12(5):833-848. doi: 10.1093/ehjqcco/qcag044. # Mental disorders, mortality following myocardial infarction, and the impact of the COVID-19 pandemic in England: a cohort study [Kelly Fleetwood](https://pubmed.ncbi.nlm.nih.gov/?term=Fleetwood+K&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [John Nolan](https://pubmed.ncbi.nlm.nih.gov/?term=Nolan+J&cauthor_id=41843746)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-2 "British Heart Foundation Data Science Centre, Health Data Research UK, London NW1 2BE, UK."), [Colin Berry](https://pubmed.ncbi.nlm.nih.gov/?term=Berry+C&cauthor_id=41843746)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-3 "School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK."), [Debbie Cavers](https://pubmed.ncbi.nlm.nih.gov/?term=Cavers+D&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [Stewart W Mercer](https://pubmed.ncbi.nlm.nih.gov/?term=Mercer+SW&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [Sandosh Padmanabhan](https://pubmed.ncbi.nlm.nih.gov/?term=Padmanabhan+S&cauthor_id=41843746)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-3 "School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK."), [Daniel J Smith](https://pubmed.ncbi.nlm.nih.gov/?term=Smith+DJ&cauthor_id=41843746)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-4 "Institute of Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh EH16 4SB, UK."), [Robert Stewart](https://pubmed.ncbi.nlm.nih.gov/?term=Stewart+R&cauthor_id=41843746)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-5 "Department of Psychological Medicine, King's College London, London SE5 8AF, UK.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-6 "South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK."), [Amanda Vettini](https://pubmed.ncbi.nlm.nih.gov/?term=Vettini+A&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [Caroline A Jackson](https://pubmed.ncbi.nlm.nih.gov/?term=Jackson+CA&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#full-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK.") Affiliations Expand ### Affiliations * 1 Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK. * 2 British Heart Foundation Data Science Centre, Health Data Research UK, London NW1 2BE, UK. * 3 School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK. * 4 Institute of Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh EH16 4SB, UK. * 5 Department of Psychological Medicine, King's College London, London SE5 8AF, UK. * 6 South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK. * PMID: **41843746** * DOI: [ 10.1093/ehjqcco/qcag044 ](https://doi.org/10.1093/ehjqcco/qcag044) Free article Item in Clipboard # Mental disorders, mortality following myocardial infarction, and the impact of the COVID-19 pandemic in England: a cohort study Kelly Fleetwood et al. Eur Heart J Qual Care Clin Outcomes. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur Heart J Qual Care Clin Outcomes Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41843746/) . 2026 Aug 11;12(5):833-848. doi: 10.1093/ehjqcco/qcag044. ### Authors [Kelly Fleetwood](https://pubmed.ncbi.nlm.nih.gov/?term=Fleetwood+K&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [John Nolan](https://pubmed.ncbi.nlm.nih.gov/?term=Nolan+J&cauthor_id=41843746)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-2 "British Heart Foundation Data Science Centre, Health Data Research UK, London NW1 2BE, UK."), [Colin Berry](https://pubmed.ncbi.nlm.nih.gov/?term=Berry+C&cauthor_id=41843746)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-3 "School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK."), [Debbie Cavers](https://pubmed.ncbi.nlm.nih.gov/?term=Cavers+D&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [Stewart W Mercer](https://pubmed.ncbi.nlm.nih.gov/?term=Mercer+SW&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [Sandosh Padmanabhan](https://pubmed.ncbi.nlm.nih.gov/?term=Padmanabhan+S&cauthor_id=41843746)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-3 "School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK."), [Daniel J Smith](https://pubmed.ncbi.nlm.nih.gov/?term=Smith+DJ&cauthor_id=41843746)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-4 "Institute of Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh EH16 4SB, UK."), [Robert Stewart](https://pubmed.ncbi.nlm.nih.gov/?term=Stewart+R&cauthor_id=41843746)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-5 "Department of Psychological Medicine, King's College London, London SE5 8AF, UK.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-6 "South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK."), [Amanda Vettini](https://pubmed.ncbi.nlm.nih.gov/?term=Vettini+A&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK."), [Caroline A Jackson](https://pubmed.ncbi.nlm.nih.gov/?term=Jackson+CA&cauthor_id=41843746)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41843746/#short-view-affiliation-1 "Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK.") ### Affiliations * 1 Usher Institute, University of Edinburgh, 5-7 Little France Road, Edinburgh BioQuarter ‒ Gate 3, Edinburgh EH16 4UX, UK. * 2 British Heart Foundation Data Science Centre, Health Data Research UK, London NW1 2BE, UK. * 3 School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK. * 4 Institute of Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh EH16 4SB, UK. * 5 Department of Psychological Medicine, King's College London, London SE5 8AF, UK. * 6 South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK. * PMID: **41843746** * DOI: [ 10.1093/ehjqcco/qcag044 ](https://doi.org/10.1093/ehjqcco/qcag044) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** People with schizophrenia experience poorer cardiovascular disease (CVD) outcomes, but other mental disorders have been little studied. We compared post-myocardial infarction (MI) mortality by mental disorder, explored whether differences in care contributed to mortality disparities, and investigated whether disparities worsened during the COVID-19 pandemic. **Methods and results:** We identified people with MI in England (November 2019-February 2023) from the Myocardial Ischaemia National Audit Programme, ascertaining mental disorder diagnoses from linked electronic health records and mortality from national death records. We used logistic regression to compare 30-day and one-year mortality between people with each of schizophrenia, bipolar disorder, or depression (of any severity) vs. those without these disorders for ST-elevation MI (STEMI) and non-STEMI (NSTEMI), adjusting for confounders and investigating differences by calendar time period. For one-year mortality, we additionally adjusted for receipt of guideline-informed care. We included 131 075 patients with NSTEMI and 79 045 with STEMI. For NSTEMI, schizophrenia [odds ratio (OR) 1.73, 95% CI 1.20-2.49] and depression (1.17, 1.08-1.26) were associated with higher 30-day mortality. For STEMI, 30-day mortality was higher in people with schizophrenia (1.61, 1.09-2.37), bipolar disorder (1.68, 1.08-2.59), and depression (1.10, 1.01-1.20). All disorders were associated with higher one-year mortality following NSTEMI and STEMI, with adjustment for care attenuating estimates. Relative mortality disparities were generally unaffected by the COVID-19 pandemic. **Conclusion:** Our findings highlight the increased risk of post-MI mortality in people with mental disorders. Improved implementation of acute cardiac care standards may help to close the gap. ## Plain language summary We used linked electronic health records from over 200 000 NSTEMI and STEMI patients in England to compare mortality following myocardial infarction by mental disorder status, evaluate whether differences in receipt of acute MI care by mental disorder might help to explain any disparities in mortality, and assess how any disparities in mortality changed following the COVID-19 pandemic. We identified mortality disparities for both NSTEMI and STEMI, which were greatest for people with schizophrenia, but also evident for bipolar disorder and depression. Our findings suggest that differences in receipt of care may contribute to poorer survival at one year. Disparities were generally unaffected by the COVID-19 pandemic. © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflict of interest: K.F., J.N., D.C., S.W.M., S.P., D.J.S., R.S., A.V., and C.A.J. declare no disclosures of interest for this work. C.B. is employed by the University of Glasgow, which holds consultancy and research agreements for his work with Abbott Vascular, AskBio, AstraZeneca, Boehringer Ingelheim, CorFlow, MSD, Novartis, Servier, Siemens Healthcare, Xylocor, and Zoll Medical. ## Comment in * [ Bridging the cardio-psychiatric divide in the era of COVID-19: a critical appraisal of post-MI outcomes in patients with mental disorders. ](https://pubmed.ncbi.nlm.nih.gov/42156231/) Zhang H, Sun L. Zhang H, et al. Eur Heart J Qual Care Clin Outcomes. 2026 Aug 11;12(5):849-851. doi: 10.1093/ehjqcco/qcag087. Eur Heart J Qual Care Clin Outcomes. 2026. PMID: 42156231 No abstract available. ## Similar articles * [ Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data. ](https://pubmed.ncbi.nlm.nih.gov/28393591/) Pinto P, Rothnie KJ, Lui K, Timmis A, Smeeth L, Quint JK.Pinto P, et al.Chron Respir Dis. 2018 Feb;15(1):60-70. doi: 10.1177/1479972317702140. Epub 2017 Apr 10.Chron Respir Dis. 2018.PMID: 28393591Free PMC article. * [ Type and timing of heralding in ST-elevation and non-ST-elevation myocardial infarction: an analysis of prospectively collected electronic healthcare records linked to the national registry of acute coronary syndromes. ](https://pubmed.ncbi.nlm.nih.gov/24222835/) Herrett E, George J, Denaxas S, Bhaskaran K, Timmis A, Hemingway H, Smeeth L.Herrett E, et al.Eur Heart J Acute Cardiovasc Care. 2013 Sep;2(3):235-45. doi: 10.1177/2048872613487495.Eur Heart J Acute Cardiovasc Care. 2013.PMID: 24222835Free PMC article. * [ Editor's Choice - Impact of initial hospital diagnosis on mortality for acute myocardial infarction: A national cohort study. ](https://pubmed.ncbi.nlm.nih.gov/27574333/) Wu J, Gale CP, Hall M, Dondo TB, Metcalfe E, Oliver G, Batin PD, Hemingway H, Timmis A, West RM.Wu J, et al.Eur Heart J Acute Cardiovasc Care. 2018 Mar;7(2):139-148. doi: 10.1177/2048872616661693. Epub 2016 Aug 29.Eur Hear
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