This English cohort study evaluated whether pre-existing mental disorders are associated with higher mortality after myocardial infarction (MI), whether differences in receipt of care explain disparities, and whether the COVID-19 pandemic altered relative risks. The analysis used national clinical audit data linked to electronic health records and death registrations to compare outcomes for people with schizophrenia, bipolar disorder, or depression versus those without these diagnoses.
Patients with MI recorded in the Myocardial Ischaemia National Audit Programme (MINAP) from November 2019 to February 2023 were included. Mental disorder diagnoses were ascertained from linked electronic health records; mortality was determined from national death records. The cohort comprised 131,075 patients with non-ST-elevation MI (NSTEMI) and 79,045 with ST-elevation MI (STEMI).
The investigators used logistic regression to estimate odds ratios (ORs) for 30-day and one-year mortality comparing people with each mental disorder to those without. Analyses were stratified by MI type (NSTEMI and STEMI) and adjusted for confounders. For one-year mortality models, an additional adjustment accounted for receipt of guideline-informed acute cardiac care to assess whether differences in care provision contributed to outcome disparities. The study also examined differences by calendar time period to explore effects related to the COVID-19 pandemic.
In the NSTEMI cohort, 30-day mortality was higher among patients with schizophrenia (OR 1.73, 95% CI 1.20–2.49) and depression (OR 1.17, 95% CI 1.08–1.26) compared with those without these disorders.
In the STEMI cohort, 30-day mortality was higher for patients 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).
These findings indicate short-term post-MI excess mortality associated with several mental disorder diagnoses, with the largest relative risks observed for schizophrenia and bipolar disorder in different MI subtypes.
All three mental disorder categories — schizophrenia, bipolar disorder, and depression — were associated with higher one-year mortality following both NSTEMI and STEMI. When models included adjustment for receipt of guideline-informed acute cardiac care, the magnitude of the associations was attenuated. This attenuation suggests that differences in the delivery or receipt of recommended acute MI care may partly mediate longer-term mortality disparities observed by mental disorder status.
The study therefore links elevated medium-term mortality after MI in people with mental disorders to both underlying vulnerability and modifiable differences in care processes.
The investigators examined whether relative mortality differences changed across calendar time periods that include the COVID-19 pandemic. Overall, relative mortality disparities by mental disorder were generally unaffected by the pandemic period assessed in this study. The authors report that elevated risks associated with mental disorders persisted despite changes in healthcare delivery during the pandemic time frame covered by the data.
Using linked health records for over 200,000 patients admitted with NSTEMI or STEMI in England, the study identified consistent post-MI mortality disparities for people with mental disorders. The greatest excess risk was seen in people with schizophrenia, but increased mortality was also evident for bipolar disorder and depression.
Adjustment for guideline-informed care reduced the strength of one-year mortality associations, implying that better implementation of acute cardiac care standards may help narrow survival gaps. The persistence of disparities through the COVID-19 period underscores the need for sustained attention to equitable delivery of acute MI care and follow-up for patients with mental health diagnoses.
The article was published in European Heart Journal — Quality of Care & Clinical Outcomes (2026) with DOI 10.1093/ehjqcco/qcag044 and PubMed ID 41843746. The author group includes clinicians and researchers affiliated with the Usher Institute, University of Edinburgh; the British Heart Foundation Data Science Centre; the University of Glasgow; King's College London; and South London and Maudsley NHS Foundation Trust.
Conflict of interest declarations reported that most authors had no disclosures. One author (Colin Berry) is employed by the University of Glasgow, which holds consultancy and research agreements with several medical and pharmaceutical companies; the other named authors declared no disclosures for this work.