TOPLINE:

Patients with severe mental illness who called emergency services reporting chest pain received more frequent acute ambulance dispatches but were less likely to be hospitalised or to receive cardiovascular diagnoses than those without the condition.

METHODOLOGY:

• This cohort study examined how patients with severe mental illness were managed when they called the emergency medical services reporting chest pain.
• Researchers used Danish registry data between 2014 and 2018 and included first-time calls to emergency medical services in Copenhagen from 64,937 adults with chest pain as the primary symptom (median age, 52-56 years; 49.8%-57.4% women).
• Patients were grouped on the basis of whether they had a prior diagnosis of severe mental illness — non-affective psychosis and schizotypal disorder, bipolar disorder, or depression — before the chest pain-related call.
• Researchers examined the emergency response after telephone triage, including an ambulance dispatch, admissions, diagnoses, and in-hospital treatments. Mortality after 30 days of the call was also assessed.

TAKEAWAY:

• Of all chest pain-related calls, 4303 were made by patients with severe mental illness and 60,634 were made by those without the condition.
• Patients with severe mental illness were more likely to receive an acute ambulance dispatch (odds ratio [OR], 1.24; 95% CI, 1.16-1.32) yet less likely to be hospitalised within 24 hours after the call (OR, 0.82; 95% CI, 0.76-0.89) than those without the condition.
• When hospitalised, fewer patients with severe mental illness received a cardiovascular diagnosis than those without the condition (P < .001); they were also less likely to receive troponin testing, coronary angiography, or revascularisation within 7-30 days.
• Mortality was similar between the two groups at 7 and 30 days.

IN PRACTICE:

"The prehospital triage of chest pain-related calls was not a substantial source of inequity in cardiovascular care of patients with severe mental illness. Instead, the disparities manifested later in the care continuum of chest pain," the researchers wrote.

SOURCE:

This study was led by Anne Storgaard Nørskov, MD, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark. It was published online on November 24, 2025, in the European Journal of Preventive Cardiology.

LIMITATIONS:

This study included only calls in which chest pain was recorded as the primary symptom, so some cases were likely missed. The severity of substance use, actual psychotropic use, and caller details were not accounted for. This registry-based study precluded any cause-effect relationships and only showed associations.

DISCLOSURES:

This study received support from the Independent Research Fund Denmark and Helsefonden. The authors did not report having any relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.