{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T01:58:47Z","timestamp":1780711127091,"version":"3.54.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T00:00:00Z","timestamp":1756598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Fond Scientifique Cardiovasculaire"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patients with mental health conditions (MHCs) experience delayed diagnosis and management. We aimed to assess whether these patients had longer treatment delays and poorer outcomes despite a dedicated ST-elevation myocardial infarction (STEMI) fast-track protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed data from EVALFAST prospective registry of confirmed STEMI patients admitted directly to the catheterization laboratory at Fribourg Hospital since June 2008. Patients were classified into MHC cohort if their electronic health record documented any MHC at STEMI diagnosis. The primary endpoint was time from the first medical contact (FMC) to diagnosis. Secondary endpoints included FMC-to-balloon time, infarct size (peak CK-MB), and 30-day and 5-year major adverse cardiac and cerebrovascular events (MACCE). We used generalized linear models adjusted for demographics, risk factors, and presentation mode, and Cox regression for survival analyses. Among 1208 patients (excluding cardiac arrests), 147 (12.1%) had documented MHC. The MHC cohort had more women (36.7 vs. 23.3%; P = 0.002) and hypertension (57.8 vs. 47.8%; P = 0.03). After adjustment, FMC-to-diagnosis time was significantly longer in MHC patients [+16.43\u2005min; 95% confidence interval (CI) +4.19 to +28.68; P = 0.009], resulting in prolonged FMC-to-balloon time (+18.63\u2005min; 95% CI +4.86 to +32.39; P = 0.008). Diagnosis-to-balloon time did not differ (P = 0.420). Delays were pronounced among patients self-presenting to emergency departments (P = 0.002). Mental health condition patients had larger infarct sizes (peak CK-MB +71.3\u2005U\/L; 95% CI +18.0 to +124.6; P = 0.009) and higher risk of 30-day MACCE [adjusted hazard ratio (HR) 1.82; 95% CI 1.05\u20133.17; P = 0.034] and 5-year cardiovascular death (adjusted HR 2.04; 95% CI 1.18\u20133.55; P = 0.011).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients presenting with STEMI, being labelled with an MHC was linked with increased delays in early management, leading to greater infarct size and higher risk of adverse cardiovascular events. Mental health conditions were associated with increased long-term years cardiovascular death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf088","type":"journal-article","created":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T11:28:47Z","timestamp":1755343727000},"page":"1431-1439","source":"Crossref","is-referenced-by-count":2,"title":["Disparities in ST-elevation myocardial infarction diagnosis and management among patients with mental health conditions"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3872-3496","authenticated-orcid":false,"given":"Dorian","family":"Garin","sequence":"first","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Mendola","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Geneva University Hospital , Rue Gabrielle-Perret-Gentil 4, Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannick","family":"Faucherre","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Bennar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tha\u00efs","family":"Pittet","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selma T","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hari","family":"Vivekanantham","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Jelisejevas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo M","family":"Cioffi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Togni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Meier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wenaweser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban","family":"Puricel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1221-2978","authenticated-orcid":false,"given":"St\u00e9phane","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University and Hospital Fribourg , Chem. des Pensionnats 2\/6, Fribourg CH-1708 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,31]]},"reference":[{"key":"2025121818524774600_qcaf088-B1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2025121818524774600_qcaf088-B2","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1056\/NEJMoa1208200","article-title":"Door-to-balloon time and mortality among patients undergoing primary PCI","volume":"369","author":"Menees","year":"2013","journal-title":"N Engl J Med"},{"key":"2025121818524774600_qcaf088-B3","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.annemergmed.2021.08.016","article-title":"Are mental health and substance use disorders risk factors for missed acute myocardial infarction diagnoses among chest pain or dyspnea encounters in the emergency department?","volume":"79","author":"Sharp","year":"2022","journal-title":"Ann Emerg Med"},{"key":"2025121818524774600_qcaf088-B4","doi-asserted-by":"crossref","first-page":"103613","DOI":"10.1016\/j.ijnurstu.2020.103613","article-title":"Psychological and cognitive factors related to prehospital delay in acute coronary syndrome: a systematic review","volume":"108","author":"Arrebola-Moreno","year":"2020","journal-title":"Int J Nurs Stud"},{"key":"2025121818524774600_qcaf088-B5","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/bjhp.12408","article-title":"Psychosocial markers of pre-hospital decision delay and psychological distress in acute coronary syndrome patients","volume":"25","author":"Arrebola-Moreno","year":"2020","journal-title":"Br J Health Psychol"},{"key":"2025121818524774600_qcaf088-B6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ajem.2022.02.037","article-title":"Disparities in cardiovascular outcomes among emergency department patients with mental illness","volume":"55","author":"Kumar","year":"2022","journal-title":"Am J Emerg Med"},{"key":"2025121818524774600_qcaf088-B7","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1503\/cmaj.100685","article-title":"The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction","volume":"183","author":"Atzema","year":"2011","journal-title":"CMAJ"},{"key":"2025121818524774600_qcaf088-B8","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/acps.13017","article-title":"Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness","volume":"139","author":"Heiberg","year":"2019","journal-title":"Acta Psychiatr Scand"},{"key":"2025121818524774600_qcaf088-B9","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1001\/jama.283.4.506","article-title":"Mental disorders and use of cardiovascular procedures after myocardial infarction","volume":"283","author":"Druss","year":"2000","journal-title":"JAMA"},{"key":"2025121818524774600_qcaf088-B10","doi-asserted-by":"publisher","author":"Mackenhauer","DOI":"10.54337\/aau499829720"},{"key":"2025121818524774600_qcaf088-B11","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1093\/eurheartj\/ehn416","article-title":"Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology","volume":"29","author":"Task Force Members","year":"2008","journal-title":"Eur Heart J"},{"key":"2025121818524774600_qcaf088-B12","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.recesp.2016.09.020","article-title":"Predictors of late reperfusion in STEMI patients undergoing primary angioplasty. Impact of the place of first medical contact","volume":"70","author":"Carol Ruiz","year":"2017","journal-title":"Rev Esp Cardiol (Eng Ed)"},{"key":"2025121818524774600_qcaf088-B13","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1161\/CIRCULATIONAHA.117.029289","article-title":"Standardized end point definitions for coronary intervention trials: the Academic Research Consortium-2 consensus document","volume":"137","author":"Garcia-Garcia","year":"2018","journal-title":"Circulation"},{"key":"2025121818524774600_qcaf088-B14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/j.2051-5545.2011.tb00022.x","article-title":"A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders","volume":"10","author":"International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders","year":"2011","journal-title":"World Psychiatry"},{"key":"2025121818524774600_qcaf088-B15","first-page":"e54402","article-title":"Understanding mental health challenges in cardiovascular care","volume":"16","author":"Borkowski","year":"2024","journal-title":"Cureus"},{"key":"2025121818524774600_qcaf088-B16","doi-asserted-by":"crossref","first-page":"E969","DOI":"10.1503\/cmaj.111043","article-title":"Wait times in the emergency department for patients with mental illness","volume":"184","author":"Atzema","year":"2012","journal-title":"CMAJ"},{"key":"2025121818524774600_qcaf088-B17","first-page":"19","article-title":"Implicit bias in healthcare professionals: a systematic review","volume":"18","author":"FitzGerald","year":"2017","journal-title":"BioMed Central"},{"key":"2025121818524774600_qcaf088-B18","doi-asserted-by":"crossref","first-page":"1435243","DOI":"10.3389\/fpsyg.2024.1435243","article-title":"Effect of mindfulness-based interventions on anxiety, depression, and stress in patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials","volume":"15","author":"Manan","year":"2024","journal-title":"Front Psychol"},{"key":"2025121818524774600_qcaf088-B19","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1111\/inm.13034","article-title":"Diagnostic overshadowing: an evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses","volume":"31","author":"Hallyburton","year":"2022","journal-title":"Int J Ment Health Nurs"},{"key":"2025121818524774600_qcaf088-B20","doi-asserted-by":"crossref","first-page":"e111682","DOI":"10.1371\/journal.pone.0111682","article-title":"Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms\u2014a qualitative study","volume":"9","author":"Shefer","year":"2014","journal-title":"PLoS One"},{"key":"2025121818524774600_qcaf088-B21","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s00068-023-02427-1","article-title":"Disparities in prehospital and emergency surgical care among patients with perforated ulcers and a history of mental illness: a nationwide cohort study","volume":"50","author":"Mackenhauer","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025121818524774600_qcaf088-B22","article-title":"Rates of detection of mood and anxiety disorders in primary care: a descriptive, cross-sectional study","volume":"13","author":"Vermani","year":"2011","journal-title":"Prim Care Companion CNS Disord"},{"key":"2025121818524774600_qcaf088-B23","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1080\/10615806.2010.493608","article-title":"What makes people anxious about pain? How personality and perception combine to determine pain anxiety responses in clinical and non-clinical populations","volume":"24","author":"Kennedy","year":"2011","journal-title":"Anxiety Stress Coping"},{"key":"2025121818524774600_qcaf088-B24","first-page":"43","article-title":"Is symptom to balloon time a better predictor of outcomes in acute ST-segment elevation myocardial infarction than door to balloon time?","volume":"8","author":"Alsamara","year":"2018","journal-title":"Am J Cardiovasc Dis"},{"key":"2025121818524774600_qcaf088-B25","first-page":"1413","article-title":"Health inequalities of STEMI care before implementation of a new regional network: a prefecture-level analysis of social determinants of healthcare in Yunnan, China","volume":"11","author":"Zhang","year":"2022","journal-title":"Int J Health Policy Manag"},{"key":"2025121818524774600_qcaf088-B26","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1186\/s12872-020-01810-9","article-title":"Efficacy of team-based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease (TEACH): study protocol of a multicenter randomized controlled trial","volume":"20","author":"Herrmann-Lingen","year":"2020","journal-title":"BMC Cardiovasc Disord"},{"key":"2025121818524774600_qcaf088-B27","doi-asserted-by":"crossref","first-page":"3813","DOI":"10.3390\/jcm10173813","article-title":"Surviving to acute myocardial infarction: the role of psychological factors and alexithymia in delayed time to searching care: a systematic review","volume":"10","author":"Sancassiani","year":"2021","journal-title":"J Clin Med"},{"key":"2025121818524774600_qcaf088-B28","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0147-9563(97)90082-0","article-title":"Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction","volume":"26","author":"Dracup","year":"1997","journal-title":"Heart Lung"},{"key":"2025121818524774600_qcaf088-B29","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1111\/j.1547-5069.2009.01287.x","article-title":"Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction","volume":"41","author":"Khraim","year":"2009","journal-title":"J Nurs Scholarsh"},{"key":"2025121818524774600_qcaf088-B30","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.pec.2008.09.019","article-title":"Predictors of pre-hospital delay among patients with acute myocardial infarction","volume":"75","author":"Khraim","year":"2009","journal-title":"Patient Educ Couns"},{"key":"2025121818524774600_qcaf088-B31","doi-asserted-by":"crossref","first-page":"e002831","DOI":"10.1136\/openhrt-2024-002831","article-title":"Sex differences in ST-segment elevation myocardial infarction patients treated by primary percutaneous intervention","volume":"12","author":"Cook","year":"2025","journal-title":"Open Heart"},{"key":"2025121818524774600_qcaf088-B32","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1093\/eurjhf\/hfq122","article-title":"Length of delay in seeking medical care by patients with heart failure symptoms and the role of symptom-related factors: a narrative review","volume":"12","author":"Gravely-Witte","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2025121818524774600_qcaf088-B33","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.jacc.2022.06.017","article-title":"Severe mental illness and cardiovascular disease: JACC state-of-the-art review","volume":"80","author":"Goldfarb","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2025121818524774600_qcaf088-B34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10253890802046281","article-title":"Stress, depression and cardiovascular dysregulation: a review of neurobiological mechanisms and the integration of research from preclinical disease models","volume":"12","author":"Grippo","year":"2009","journal-title":"Stress"},{"key":"2025121818524774600_qcaf088-B35","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1093\/ajh\/hpv047","article-title":"State of the art review: depression, stress, anxiety, and cardiovascular disease","volume":"28","author":"Cohen","year":"2015","journal-title":"Am J Hypertens"},{"key":"2025121818524774600_qcaf088-B36","doi-asserted-by":"crossref","first-page":"100133","DOI":"10.1016\/j.ajpc.2020.100133","article-title":"Mental health disorders among patients with acute myocardial infarction in the United States","volume":"5","author":"Sreenivasan","year":"2021","journal-title":"Am J Prev Cardiol"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcaf088\/64129158\/qcaf088.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/8\/1431\/64129158\/qcaf088.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/8\/1431\/64129158\/qcaf088.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T23:52:59Z","timestamp":1766101979000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/11\/8\/1431\/8241036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,31]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,31]]},"published-print":{"date-parts":[[2025,12,19]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcaf088","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,8,31]]}}}