{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:25:46Z","timestamp":1786962346585,"version":"build-2736575974"},"reference-count":23,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Interv Cardiol"],"abstract":"<jats:p>Background: People with severe mental illness (SMI) experience significant health disparities, including in cardiovascular care. This study used natural language processing (NLP), an artificial intelligence method, to investigate care pathways for SMI patients within a highly protocolised urban primary angioplasty network for ST-elevation MI (STEMI). Methods: This cohort study used NLP to extract SMI diagnoses and clinical data from free-text electronic health records, including STEMI and non-STEMI audit data. Primary outcomes included 28-day and 1-year mortality, with secondary outcomes examining pathway performance metrics and procedural data. Exploratory outcomes assessed presenting symptoms and comorbidities. Results: A total of 2,292 adults presented with first-time STEMI from 2012\u20132019, of whom 51 (2.2%) had recorded SMI diagnoses. No significant differences were found in mortality between SMI and non-SMI patients at 28-day and 1-year, although a non-significant trend toward higher crude mortality in SMI patients emerged at 3 years (23.5% versus 16.1%; p=0.152). Procedure metrics and timings were similar between groups. SMI patients were more likely to have presented with cardiac arrest (adjusted OR 2.48; 95% CI [1.18\u20135.22]; p=0.017) and had higher rates of chronic obstructive pulmonary disease (adjusted OR 2.20; 95% CI [1.00\u20134.83]; p=0.049). Percutaneous coronary intervention rates in SMI patients with a non-STEMI were less than their representation in the overall non-STEMI population (2.2% versus 3.3%; p=0.042). Conclusion: Highly protocolised STEMI pathways appear to provide equitable acute care for patients with SMI without excess short-term mortality. However, potential disparities emerge in longer-term outcomes and in non-STEMI treatment pathways, suggesting a need for improved secondary prevention and targeted interventions for this vulnerable population.<\/jats:p>","DOI":"10.15420\/icr.2025.23","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T09:38:25Z","timestamp":1786959505000},"source":"Crossref","is-referenced-by-count":0,"title":["Assessing Care of Patients with Severe Mental Illness in the Era of Primary Angioplasty Pathways for ST-elevation MI Using Artificial Intelligence Methods"],"prefix":"10.15420","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4137-4220","authenticated-orcid":false,"given":"Eoin","family":"Gogarty","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King's College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7694-2593","authenticated-orcid":false,"given":"Isabelle","family":"Sweeney","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King's College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Tam To","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01n0k5m85","id-type":"ROR","asserted-by":"publisher"}],"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6043-5450","authenticated-orcid":false,"given":"Jack","family":"Wu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King's College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6547-0631","authenticated-orcid":false,"given":"Ajay M","family":"Shah","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01n0k5m85","id-type":"ROR","asserted-by":"publisher"}],"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7414-5569","authenticated-orcid":false,"given":"Fiona","family":"Gaughran","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220mzb33","id-type":"ROR","asserted-by":"publisher"}],"name":"King's College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2218-4763","authenticated-orcid":false,"given":"Kevin","family":"O\u2019Gallagher","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01n0k5m85","id-type":"ROR","asserted-by":"publisher"}],"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Tam To B, Roy R, Melikian N, et al. Coronary artery disease in patients with severe mental illness. Interv Cardiol 2023;18:e16. https:\/\/doi.org\/10.15420\/icr.2022.31; PMID:\u00a037398869.","DOI":"10.15420\/icr.2022.31"},{"key":"ref1","unstructured":"Public health England. Severe mental illness (SMI) and physical health inequalities: briefing. 2018. https:\/\/www.gov.uk\/government\/publications\/severe-mental-illness-smi-physical-health-inequalities\/severe-mental-illness-and-physical-health-inequalities-briefing (accessed 4\u00a0November 2024)"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Shah C, Singh P, Matin S, et al. A physician associate-led clinic for people with severe mental illness in the United Kingdom. JAAPA 2021;34:1\u20136. https:\/\/doi.org\/10.1097\/01.JAA.0000758220.38067.49; PMID:\u00a034320547.","DOI":"10.1097\/01.JAA.0000758220.38067.49"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Hamer M, Stamatakis E, Steptoe A. Psychiatric hospital admissions, behavioral risk factors, and all-cause mortality: the Scottish Health Survey. Arch Intern Med 2008;168:2474\u20139. https:\/\/doi.org\/10.1001\/archinte.168.22.2474; PMID:\u00a019064832.","DOI":"10.1001\/archinte.168.22.2474"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Newcomer JW, Hennekens CH. Severe mental illness and risk of cardiovascular disease. JAMA 2007;298:1794\u20136. https:\/\/doi.org\/10.1001\/jama.298.15.1794; PMID:\u00a017940236.","DOI":"10.1001\/jama.298.15.1794"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"McCreadie RG, Scottish Schizophrenia Lifestyle Group. Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry 2003;183:534\u20139. https:\/\/doi.org\/10.1192\/bjp.183.6.534; PMID:\u00a014645025.","DOI":"10.1192\/03-162"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Firth J, Siddiqi N, Koyanagi A, et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019;6:675\u2013712. https:\/\/doi.org\/10.1016\/S2215-0366(19)30132-4; PMID:\u00a031324560.","DOI":"10.1016\/S2215-0366(19)30387-6"},{"key":"ref7","unstructured":"WHO. Cardiovascular diseases. 2026. https:\/\/www.who.int\/health-topics\/cardiovascular-diseases (accessed 10\u00a0July 2024)."},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Jakobsen L, Terkelsen CJ, Christiansen EH, et al. Severe mental illness and clinical outcome after primary percutaneous coronary intervention. Am J Cardiol 2017;120:550\u20135. https:\/\/doi.org\/10.1016\/j.amjcard.2017.05.021; PMID:\u00a028645474.","DOI":"10.1016\/j.amjcard.2017.05.021"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Attar R, Wester A, Koul S, et al. Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia. Open Heart 2020;7:e001286. https:\/\/doi.org\/10.1136\/openhrt-2020-001286; PMID:\u00a032994353.","DOI":"10.1136\/openhrt-2020-001286"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Jackson R, Kartoglu I, Stringer C, et al. CogStack \u2013 experiences of deploying integrated information retrieval and extraction services in a large National Health Service Foundation Trust hospital. BMC Med Inform Decis Mak 2018;18:47. https:\/\/doi.org\/10.1186\/s12911-018-0623-9; PMID:\u00a029941004.","DOI":"10.1186\/s12911-018-0623-9"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Kraljevic Z, Searle T, Shek A, et al. Multi-domain clinical natural language processing with MedCAT: the Medical Concept Annotation Toolkit. Artif Intell Med 2021;117:102083. https:\/\/doi.org\/10.1016\/j.artmed.2021.102083; PMID:\u00a034127232.","DOI":"10.1016\/j.artmed.2021.102083"},{"key":"ref12","unstructured":"Farran D, Bean D, Wang T, et al. Anticoagulation for atrial fibrillation in people with serious mental illness in the general hospital setting. J Psychiatr Res 2022;153:167\u201373. https:\/\/doi.org\/10.1016\/j.jpsychires.2022.06.044; PMID:\u00a035816976."},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Flanagin A, Frey T, Christiansen SL, AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA 2021;326:621\u20137. https:\/\/doi.org\/10.1001\/jama.2021.13304; PMID:\u00a034402850.","DOI":"10.1001\/jama.2021.13304"},{"key":"ref14","unstructured":"Ministry of Housing, Communities & Local Government. English indices of deprivation 2019. 2019. https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2019 (accessed 2\u00a0December 2024)."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Park J, Choi KH, Lee JM, et al. Prognostic implications of door-to-balloon time and onset-to-door time on mortality in patients with ST -segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. J Am Heart Assoc 2019;8:e012188. https:\/\/doi.org\/10.1161\/JAHA.119.012188; PMID:\u00a031041869.","DOI":"10.1161\/JAHA.119.012188"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Fleetwood K, Wild SH, Smith DJ, et al. Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study. BMC Med 2021;19:67. https:\/\/doi.org\/10.1186\/s12916-021-01937-2; PMID:\u00a033745445.","DOI":"10.1186\/s12916-021-01937-2"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Bod\u00e9n R, Molin E, Jernberg T, et al. Higher mortality after myocardial infarction in patients with severe mental illness: a nationwide cohort study. J Intern Med 2015;277:727\u201336. https:\/\/doi.org\/10.1111\/joim.12329; PMID:\u00a025404197.","DOI":"10.1111\/joim.12329"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Marchand WE. Occurrence of painless myocardial infarction in psychotic patients. N Engl J Med 1955;253:51\u20135. https:\/\/doi.org\/10.1056\/NEJM195507142530202; PMID:\u00a014394322.","DOI":"10.1056\/NEJM195507142530202"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Hallyburton A. Diagnostic overshadowing: an evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses. Int J Ment Health Nurs 2022;31:1360\u201372. https:\/\/doi.org\/10.1111\/inm.13034; PMID:\u00a035718951.","DOI":"10.1111\/inm.13034"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Ya\u2019qoub L, Lemor A, Dabbagh M, et al. Racial, ethnic, and sex disparities in patients with STEMI and cardiogenic shock. JACC Cardiovasc Interv 2021;14:653\u201360. https:\/\/doi.org\/10.1016\/j.jcin.2021.01.003; PMID:\u00a033736772.","DOI":"10.1016\/j.jcin.2021.01.003"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Stubbs B, Thompson T, Acaster S, et al. Decreased pain sensitivity among people with schizophrenia: a meta-analysis of experimental pain induction studies. Pain 2015;156:2121\u201331. https:\/\/doi.org\/10.1097\/j.pain.0000000000000304; PMID:\u00a026207650.","DOI":"10.1097\/j.pain.0000000000000304"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Mansour H, Mueller C, Davis KAS, et al. Severe mental illness diagnosis in English general hospitals 2006\u20132017: a registry linkage study. 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