People with depression get slower ER care for heart attacks

Heart disease and depression often go together, for reasons that physicians don’t really understand. So it would seem an especially bitter pill that patients with depression who are suffering from heart attacks get slower care at emergency rooms.

Such is the finding from a paper just published in the Canadian Medical Assn. journal, known as CMAJ. The authors suggest this could be one reason among a number why depressed patients with heart disease have poorer medical outcomes than people with heart disease but no depression. (There are lots of others, such as the fact that people who are depressed are less likely to change their lifestyle in ways that would help their heart.)

Related: Medicine pursues a mind-heart connection.

The scientists looked at 6,784 patients visiting Ontario, Canada ERs in 2004 and 2005, all for what turned out to be heart attacks. Of those, 680 had a history of depression.

Of the depressed group, 39% were given a low-priority assignment after triage at the ER; that compares with 32.7% for those without a history of depression. The most likely explanation, the authors say, is that patients with a history of depression were more likely to be diagnosed as having some kind of anxiety attack or feelings that were psychosomatic. After all, symptoms such as chest pain and shortness of breath go along with both conditions.

That translates to longer waits before key procedures were performed:

--A median of 20 minutes for an EKG test, versus 17 minutes for non-depressed people.

--A median of 53 minutes until fibrinolysis (breaking down of a blood clot) versus 37 minutes for the non-depressed.

--And 251 minutes until expansion of a balloon during interventions to dilate the blocked coronary artery (110 minutes for the non-depressed).

Despite the fact that the link between heart disease and depression is becoming more and more established, the authors write that they suspect the link isn’t as well-known by ER staff as it should be. Maybe things have changed in the last five years.

Here’s a link to the study for those who are interested. (Hooray, it’s one where you can read the whole thing without paying.)