Quality of Medical Care and Excess Mortality in Older Patients With Mental Disorders

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Abstract
MUCH LITERATURE has demonstrated that patients with mental disorders are at risk for elevated rates of cardiovascular mortality.%1-8 Authors have postulated that arrhythmogenic, neuroendocrine, or other direct physiological mechanisms mediate this excess mortality,%9,10 and thus previous studies of mortality in mental disorders have generally not examined the quality of these patients' medical care. However, patterns of cardiac procedures after acute myocardial infarction (AMI) have been found to differ substantially for patients with and without mental disorders,%11 raising the question as to whether there may also be a gap in quality of medical care. If quality of care does vary, such differences might play a role in mediating excess cardiovascular mortality in patients with mental disorders.