Programme no. 455-P
Public Health
Healthcare contacts after myocardial infarction according to mental health and socioeconomic position
Tine Jepsen Nielsen*1, Morten Fenger-Grøn2, Mogens Vestergaard3, Bo Christensen4, Karen Kjær Larsen5
1Mental Health in Primary Care (MEPRICA), Research Unit for General Practice, Department of Public Health, Aarhus University,Aarhus C,Denmark, 2Mental Health in Primary Care (MEPRICA), Research Unit for General Practice, Department of Public Health, Aarhus University,Aarhus C,Denmark, 3Mental Health in Primary Care (MEPRICA), Research Unit for General Practice, Department of Public Health, Aarhus University,Aarhus C,Denmark;Section for General Medical Practice, Department of Public Health, Aarhus University,Aarhus C,Denmark, 4Section for General Medical Practice, Department of Public Health, Aarhus University,Aarhus C,Denmark, 5Mental Health in Primary Care (MEPRICA), Research Unit for General Practice, Department of Public Health, Aarhus University,Aarhus C,Denmark;Section for General Medical Practice, Department of Public Health, Aarhus University,Aarhus C,Denmark
* = Presenting author
Objectives: To examine the long-term use of healthcare contacts to general practice (GP) and hospital after a first-time MI according to mental health and socioeconomic position.
Background: Mounting evidence suggests that mental health and socioeconomic position play an important role for the prognosis after myocardial infarction (MI). Part of the explanation may be low use of healthcare after MI among these patients.
Results: During the 24-month period after the MI, patients with anxiety symptoms had 24% more GP contacts (adjusted IRR 1.24, 95% CI 1.12-1.36) than patients with no anxiety symptoms. In contrast, patients with depressive symptoms (1.05, 0.94-1.16), short and medium education (<10 years: 0.96, 0.84-1.08; 10-12 years: 0.91, 0.80-1.03) and patients living alone (0.95, 0.87-1.04) had the same number of GP contacts as their counterparts (patients with no depressive symptoms, with long education (>12 years) and patients living with a partner). During the first 6 months after the MI, patients living alone had 13% fewer hospital contacts (0.87, 0.77-0.99), patients with short education had 16% fewer hospital contacts (<10 years: 0.84, 0.72-0.98) and patients with anxiety symptoms had 27% fewer hospital contacts (0.73, 0.62-0.86) than their counterparts. In contrast, patients with depressive symptoms (0.92, 0.77-1.10) and medium education (10-12 years: 1.05, 0.91-1.22) had the same number of hospital contacts as their counterparts.
Material/Methods: Population-based cohort study of all patients discharged with first-time MI in the Central Denmark Region in 2009 (n=908). We estimated adjusted incidence rates and incidence rate ratios (IRR) for GP and hospital contacts according to depressive and anxiety symptoms, educational level and cohabitation status.
Conclusion: This study indicates that patients with depressive symptoms, short and medium education and patients living alone have a lower long-term use of healthcare contacts following MI than patients without these risk factors. Patients with depressive symptoms and low socioeconomic position would be expected to have a higher need of healthcare after MI as they have a poorer prognosis.
Points for discussion: Low socioeconomic position and depressive symptoms after MI have consistently been associated with mortality, whereas anxiety symptoms have not. Part of this difference in prognosis may be explained by differences in the use of healthcare.

More contacts to the healthcare system among MI patients with depressive symptoms and low socioeconomic position may lead to a more optimised treatment, less severe cardiac disease and lower mortality. This may be achieved through differentiated and outreaching treatment strategies for patients with these risk factors.