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Wittink M, Chan AC, Padrino S, Silverstein SM. The Undervalued Potential of Medical-Psychiatry Units to Improve Care for People With Severe Mental Illnesses. Psychiatr Serv 2023; 74:991-993. [PMID: 36820518 DOI: 10.1176/appi.ps.202200039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Aubrey C Chan
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Susan Padrino
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Wittink, Silverstein); Medical-Psychiatry Unit Consortium, Association of Medicine and Psychiatry, Fresno, California (Wittink, Chan, Padrino); Departments of Psychiatry and Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City (Chan); Departments of Psychiatry and Internal Medicine, University Hospitals Cleveland Medical Center, and AbsoluteCare Cleveland, Cleveland (Padrino)
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2
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Natividad M, Seeman MV, Paolini JP, Balagué A, Román E, Bagué N, Izquierdo E, Salvador M, Vallet A, Pérez A, Monreal JA, González-Rodríguez A. Monitoring the Effectiveness of Treatment in Women with Schizophrenia: New Specialized Cooperative Approaches. Brain Sci 2023; 13:1238. [PMID: 37759839 PMCID: PMC10526759 DOI: 10.3390/brainsci13091238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Women with schizophrenia have specific health needs that differ from those of men and that change through successive life stages. We aimed to review the biopsychosocial literature on schizophrenia that addresses clinically important questions related to the treatment of women, including somatic morbi-mortality, hyperprolactinemia, comorbid substance use disorders, social risk factors, and medication effectiveness/safety. Data search terms were as follows: (Morbidity AND mortality) OR hyperprolactinemia OR ("substance use disorders" OR addictions) OR ("social risk factors") OR ("drug safety" OR prescription) AND women AND schizophrenia. A secondary aim was to describe a method of monitoring and interdisciplinary staff strategies. Schizophrenia patients show an increased risk of premature death from cardiovascular/respiratory disease and cancer compared to the general population. The literature suggests that close liaisons with primary care and the introduction of physical exercise groups reduce comorbidity. Various strategies for lowering prolactin levels diminish the negative long-term effects of hyperprolactinemia. Abstinence programs reduce the risk of victimization and trauma in women. Stigma associated with women who have serious psychiatric illness is often linked to reproductive functions. The safety and effectiveness of antipsychotic drug choice and dose differ between men and women and change over a woman's life cycle. Monitoring needs to be multidisciplinary, knowledgeable, and regular.
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Affiliation(s)
- Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada;
| | - Jennipher Paola Paolini
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Ariadna Balagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eloïsa Román
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Noelia Bagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eduard Izquierdo
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mireia Salvador
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anna Vallet
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anabel Pérez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - José A. Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
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3
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Biazus TB, Beraldi GH, Tokeshi L, Rotenberg LDS, Dragioti E, Carvalho AF, Solmi M, Lafer B. All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mol Psychiatry 2023; 28:2508-2524. [PMID: 37491460 PMCID: PMC10611575 DOI: 10.1038/s41380-023-02109-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality. RESULTS Fifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings. CONCLUSION Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.
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Affiliation(s)
- Taís Boeira Biazus
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Schizophrenia Research Program (Projesq), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tokeshi
- Consultation Liaison, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luísa de Siqueira Rotenberg
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE 58185, Linköping, Sweden
| | - André F Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Beny Lafer
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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4
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Tam To B, Roy R, Melikian N, Gaughran FP, O’Gallagher K. Coronary Artery Disease in Patients with Severe Mental Illness. Interv Cardiol 2023; 18:e16. [PMID: 37398869 PMCID: PMC10311395 DOI: 10.15420/icr.2022.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/23/2022] [Indexed: 07/04/2023] Open
Abstract
Severe mental illnesses (SMI), such as schizophrenia and bipolar disorder, are associated with a decrease in life expectancy of up to two decades compared with the general population, with cardiovascular disease as the leading cause of death. SMI is associated with increased cardiovascular risk profile and early onset of incident cardiovascular disease. Following an acute coronary syndrome, patients with SMI have a worse prognosis, but are less likely to receive invasive treatment. In this narrative review, the management of coronary artery disease in patients with SMI is discussed, and avenues for future research are highlighted.
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Affiliation(s)
- Brian Tam To
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
| | - Roman Roy
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
| | - Narbeh Melikian
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King’s College LondonLondon, UK
| | - Fiona P Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondon, UK
- National Psychosis Service, South London and Maudsley NHS Foundation TrustLondon, UK
| | - Kevin O’Gallagher
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King’s College LondonLondon, UK
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5
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Launders N, Dotsikas K, Marston L, Price G, Osborn DPJ, Hayes JF. The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis. PLoS One 2022; 17:e0272498. [PMID: 35980891 PMCID: PMC9387848 DOI: 10.1371/journal.pone.0272498] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background People with severe mental illness (SMI) are at higher risk of physical health conditions compared to the general population, however, the impact of specific underlying health conditions on the use of secondary care by people with SMI is unknown. We investigated hospital use in people managed in the community with SMI and five common physical long-term conditions: cardiovascular diseases, COPD, cancers, diabetes and liver disease. Methods We performed a systematic review and meta-analysis (Prospero: CRD42020176251) using terms for SMI, physical health conditions and hospitalisation. We included observational studies in adults under the age of 75 with a diagnosis of SMI who were managed in the community and had one of the physical conditions of interest. The primary outcomes were hospital use for all causes, physical health causes and related to the physical condition under study. We performed random-effects meta-analyses, stratified by physical condition. Results We identified 5,129 studies, of which 50 were included: focusing on diabetes (n = 21), cardiovascular disease (n = 19), COPD (n = 4), cancer (n = 3), liver disease (n = 1), and multiple physical health conditions (n = 2). The pooled odds ratio (pOR) of any hospital use in patients with diabetes and SMI was 1.28 (95%CI:1.15–1.44) compared to patients with diabetes alone and pooled hazard ratio was 1.19 (95%CI:1.08–1.31). The risk of 30-day readmissions was raised in patients with SMI and diabetes (pOR: 1.18, 95%CI:1.08–1.29), SMI and cardiovascular disease (pOR: 1.27, 95%CI:1.06–1.53) and SMI and COPD (pOR:1.18, 95%CI: 1.14–1.22) compared to patients with those conditions but no SMI. Conclusion People with SMI and five physical conditions are at higher risk of hospitalisation compared to people with that physical condition alone. Further research is warranted into the combined effects of SMI and physical conditions on longer-term hospital use to better target interventions aimed at reducing inappropriate hospital use and improving disease management and outcomes.
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Affiliation(s)
- Naomi Launders
- Division of Psychiatry, UCL, London, United Kingdom
- * E-mail:
| | | | - Louise Marston
- Department of Primary Care and Population Health, UCL, London, United Kingdom
| | - Gabriele Price
- Health Improvement Directorate, Public Health England, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Joseph F. Hayes
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
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6
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Philipsen L, Würtz N, Polcwiartek C, Kragholm KH, Torp-Pedersen C, Nielsen RE, Jensen SE, Attar R. Time trends of coronary procedures, guideline-based drugs and all-cause mortality following acute coronary syndrome in patients with bipolar disorder. Nord J Psychiatry 2022; 77:304-311. [PMID: 35904234 DOI: 10.1080/08039488.2022.2102208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM This study analyzed time trends in the use of coronary procedures, guideline-based drugs, and 1-year all-cause and presumed cardiovascular mortality (CV) following acute coronary syndrome (ACS) in patients with and without bipolar disorder (BD). METHOD Using Danish registries 497 patients with ACS and BD in the period 1996-2016 were matched 1:2 on age, sex and year of ACS to patients without preexisting psychiatric disease. RESULTS Patients with BD and ACS received fewer coronary angiography (CAG) compared to psychiatric healthy controls (PHC). However, the difference between the populations decreased over time. For percutaneous coronary intervention (PCI) and coronary artery bypass (CABG) no differences in trend over time were found. In general patients with BD redeemed fewer prescriptions of guideline-based tertiary prophylactic drugs compared to PHCs. The difference remains constant over time for all drugs except for acetylsalicylic acid, lipid-lowering drugs and beta blockers, where the difference decreased. The 1-year all-cause mortality gap and the presumed CV mortality gap remained unchanged. CONCLUSION Despite improvements in treatment disparities regarding CAG, acetylsalicylic acid, lipid-lowering drugs and beta-blockers, the treatment gap remained unchanged concerning PCI and CABG. Likewise, patients with BD experienced a lower rate of the remaining redeemed prescriptions. The overall crude mortality risk ratio for patients with BD experiencing ACS remained unchanged over the study period compared to PHC.
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Affiliation(s)
- Line Philipsen
- Student, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna Würtz
- Student, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerød, Denmark.,Department of Health Sciences and Technology, Aalborg University, Aalborg, Denmark
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rubina Attar
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
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7
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Chan JKN, Chu RST, Hung C, Law JWY, Wong CSM, Chang WC. Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull 2022; 48:981-998. [PMID: 35786737 PMCID: PMC9434477 DOI: 10.1093/schbul/sbac070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND HYPOTHESIS People with severe mental illness (SMI) may experience excess mortality and inequitable treatment following acute coronary syndrome (ACS). However, cardioprotective pharmacotherapy and SMI diagnoses other than schizophrenia are rarely examined in previous reviews. We hypothesized that SMI including bipolar disorder (BD) is associated with increased post-ACS mortality, decreased revascularization, and cardioprotective medication receipt relative to those without SMI. STUDY DESIGN We performed a meta-analysis to quantitatively synthesize estimates of post-ACS mortality, major adverse cardiac events (MACEs), and receipt of invasive coronary procedures and cardioprotective medications in patients with SMI, comprising schizophrenia, BD, and other nonaffective psychoses, relative to non-SMI counterparts. Subgroup analyses stratified by SMI subtypes (schizophrenia, BD), incident ACS status, and post-ACS time frame for outcome evaluation were conducted. STUDY RESULTS Twenty-two studies were included (n = 12 235 501, including 503 686 SMI patients). SMI was associated with increased overall (relative risk [RR] = 1.40 [95% confidence interval = 1.21-1.62]), 1-year (1.68 [1.42-1.98]), and 30-day (1.26 [1.05-1.51]) post-ACS mortality, lower receipt of revascularization (odds ratio = 0.57 [0.49-0.67]), and cardioprotective medications (RR = 0.89 [0.85-0.94]), but comparable rates of any/specific MACEs relative to non-SMI patients. Incident ACS status conferred further increase in post-ACS mortality. Schizophrenia was associated with heightened mortality irrespective of incident ACS status, while BD was linked to significantly elevated mortality only in incident ACS cohort. Both schizophrenia and BD patients had lower revascularization rates. Post-ACS mortality risk remained significantly increased with mild attenuation after adjusting for revascularization. CONCLUSIONS SMI is associated with increased post-ACS mortality and undertreatment. Effective multipronged interventions are urgently needed to reduce these physical health disparities.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ryan Sai Ting Chu
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chun Hung
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jenny Wai Yiu Law
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- To whom correspondence should be addressed; Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: (852) 22554486, fax: (852) 28551345, e-mail:
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8
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Cardiovascular disease risk in people with severe mental disorders: an update and call for action. Curr Opin Psychiatry 2022; 35:277-284. [PMID: 35781467 DOI: 10.1097/yco.0000000000000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is a major cause of premature death in people with severe mental disorders (SMDs). This review provides an update on the level of CVD mortality and morbidity, as well as the socioeconomic, psychosocial and genetic factors associated with the comorbidity, and offer directions for improved interventions to reduce CVD in SMDs. RECENT FINDINGS The level of CVD mortality and morbidity has sustained high in people with SMDs during the past decades, but the causal mechanism must be further elucidated. Psychosocial and socioeconomic challenges are frequent in SMDs as well as in CVD. Further, recent studies have revealed genetic variants jointly associated with SMDs, CVD risk and social factors. These findings highlight the need for more targeted interventions, prediction tools and psychosocial approaches to comorbid CVD in SMDs. SUMMARY The level of CVD comorbidity remains high in SMDs, indicating that most people with SMDs have not benefitted from recent medical advances. A complex interplay between genetic and social vulnerability to CVD, which differs across subgroups of patients, seems to be involved. Further research is required to meet the urgent need for earlier, more efficient intervention approaches and preventive strategies for comorbid CVD in SMD.
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9
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O'Gallagher K, Teo JTH, Shah AM, Gaughran F. Interaction Between Race, Ethnicity, Severe Mental Illness, and Cardiovascular Disease. J Am Heart Assoc 2022; 11:e025621. [PMID: 35699192 PMCID: PMC9238657 DOI: 10.1161/jaha.121.025621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Severe mental illnesses, such as schizophrenia or bipolar disorder, affect ≈1% of the population who, as a group, experience significant disadvantage in terms of physical health and reduced life expectancy. In this review, we explore the interaction between race, ethnicity, severe mental illness, and cardiovascular disease, with a focus on cardiovascular care pathways. Finally, we discuss strategies to investigate and address disparities in cardiovascular care for patients with severe mental illness.
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Affiliation(s)
- Kevin O'Gallagher
- British Heart Foundation Centre of Research ExcellenceKing’s College LondonLondonUnited Kingdom
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - James TH. Teo
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
| | - Ajay M. Shah
- British Heart Foundation Centre of Research ExcellenceKing’s College LondonLondonUnited Kingdom
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
- South London and Maudsley NHS Foundation TrustLondonUnited Kingdom
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10
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Attar R, Valentin JB, Andell P, Nielsen RE, Jensen SE. Major adverse cardiovascular events following acute coronary syndrome in patients with bipolar disorder. Int J Cardiol 2022; 363:1-5. [PMID: 35716946 DOI: 10.1016/j.ijcard.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons with bipolar disorder (BD) have a higher cardiovascular mortality compared to the general population, partially explained by the increased burden of cardiovascular risk factors. Research regarding outcomes following acute coronary syndrome (ACS) in this population remains scarce. DESIGN This Danish register-based study included patients diagnosed with BD and ACS in the period between January 1st, 1995, to December 31st, 2013. Study participants were matched 1:2 to patients without BD on sex, date of birth, time of ACS diagnosis and comorbidities. The primary outcome of interest was major adverse cardiovascular events (MACE) a composite of all-cause mortality, reinfarction or stroke. MACE and its individual components were compared between patients with and without BD. RESULTS 796 patients with BD were compared to 1592 patients without BD, both groups had a mean age of first ACS of 66.5 years. MACE was 38% increased (HR 1.38 95% CI 1.25-1.54), all-cause mortality was 71% increased (HR 1.71 95% CI 1.52-1.92), stroke was 94% increased (HR 1.94 95% CI 1.56-2.41) and reinfarction rates were 17% lower (HR 0.83 95% CI 0.69-1.00) in the BD population compared to the population without BD. We also found higher prevalences of heart failure (9.1% vs. 6.5%), valve disease (5.3% vs. 3.5%), anemia (8.7% vs. 5.8%), chronic obstructive pulmonary disease (13.4% vs. 9.3%) and stroke (11.8% vs. 7.8%) in the population with BD at baseline, all p-values <0.05. CONCLUSION Bipolar disorder was associated with a higher risk of composite MACE, all-cause mortality, and stroke, after ACS compared to patients without BD.
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Affiliation(s)
- Rubina Attar
- Department of Cardiology, Department of Cardiology and Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
| | - Jan Brink Valentin
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Pontus Andell
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden..
| | | | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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11
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Hannoodee H, Al Khalili M, Theik NWY, Raji OE, Shenwai P, Shah R, Kalluri SR, Bhutta TH, Khan S. The Outcomes of Acute Coronary Syndrome in Patients Suffering From Schizophrenia: A Systematic Review. Cureus 2021; 13:e16998. [PMID: 34540400 PMCID: PMC8423112 DOI: 10.7759/cureus.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/05/2022] Open
Abstract
Acute coronary syndrome (ACS) is a principal cause of mortality and morbidity worldwide. Recent studies have suggested poorer outcomes in ACS patients who have a concurrent diagnosis of schizophrenia as compared with those without. However, the degree of interplay between schizophrenia and ACS remains poorly understood. For this reason, we conducted a systematic review on ACS outcomes in patients with schizophrenia by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We collected relevant data from PubMed, Cochrane Library, PubMed central, Jisc Library Hub Discover, and the National Library of Medicine (NLM) and performed a thorough quality appraisal. Fourteen shortlisted, relevant studies were meticulously reviewed. Mortality and major adverse cardiac events (MACE), bleeding, and stroke were more prevalent in patients with a schizophrenia diagnosis compared to those without. Additionally, schizophrenia patients received suboptimal care and follow-up when compared to patients without a psychiatric diagnosis. Clinicians need to be aware that patients with schizophrenia have worse outcomes following ACS which may relate to biological, health care, or patient-related factors.
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Affiliation(s)
- Hanan Hannoodee
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mahmoud Al Khalili
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nyein Wint Yee Theik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Oluwatimilehin E Raji
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Priya Shenwai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rutul Shah
- Internal Medicine, M.P. Shah Government Medical College, Jamnagar, IND
| | - Sahithi Reddy Kalluri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tinaz H Bhutta
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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12
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Lister J, Han L, Bellass S, Taylor J, Alderson SL, Doran T, Gilbody S, Hewitt C, Holt RIG, Jacobs R, Kitchen CEW, Prady SL, Radford J, Ride JR, Shiers D, Wang HI, Siddiqi N. Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background
People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap.
Objectives
The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness.
Design
Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews.
Setting
The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber).
Participants
The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff.
Data sources
The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation.
Results
People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’).
Limitations
Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices.
Conclusions
People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone.
Future work
These findings can inform the development of targeted interventions aimed at addressing inequalities in this population.
Study registration
National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jennie Lister
- Department of Health Sciences, University of York, York, UK
| | - Lu Han
- Department of Health Sciences, University of York, York, UK
| | - Sue Bellass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jo Taylor
- Department of Health Sciences, University of York, York, UK
| | - Sarah L Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Richard IG Holt
- Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | | | | | - John Radford
- Patient and public involvement representative, Keighley, UK
| | - Jemimah R Ride
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Primary Care and Health Sciences, Keele University, Keele, UK
| | - Han-I Wang
- Department of Health Sciences, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
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13
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Fleetwood K, Wild SH, Smith DJ, Mercer SW, Licence K, Sudlow CLM, Jackson CA. Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study. BMC Med 2021; 19:67. [PMID: 33745445 PMCID: PMC7983231 DOI: 10.1186/s12916-021-01937-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI), comprising schizophrenia, bipolar disorder and major depression, is associated with higher myocardial infarction (MI) mortality but lower coronary revascularisation rates. Previous studies have largely focused on schizophrenia, with limited information on bipolar disorder and major depression, long-term mortality or the effects of either sociodemographic factors or year of MI. We investigated the associations between SMI and MI prognosis and how these differed by age at MI, sex and year of MI. METHODS We conducted a national retrospective cohort study, including adults with a hospitalised MI in Scotland between 1991 and 2014. We ascertained previous history of schizophrenia, bipolar disorder and major depression from psychiatric and general hospital admission records. We used logistic regression to obtain odds ratios adjusted for sociodemographic factors for 30-day, 1-year and 5-year mortality, comparing people with each SMI to a comparison group without a prior hospital record for any mental health condition. We used Cox regression to analyse coronary revascularisation within 30 days, risk of further MI and further vascular events (MI or stroke). We investigated associations for interaction with age at MI, sex and year of MI. RESULTS Among 235,310 people with MI, 923 (0.4%) had schizophrenia, 642 (0.3%) had bipolar disorder and 6239 (2.7%) had major depression. SMI was associated with higher 30-day, 1-year and 5-year mortality and risk of further MI and stroke. Thirty-day mortality was higher for schizophrenia (OR 1.95, 95% CI 1.64-2.30), bipolar disorder (OR 1.53, 95% CI 1.26-1.86) and major depression (OR 1.31, 95% CI 1.23-1.40). Odds ratios for 1-year and 5-year mortality were larger for all three conditions. Revascularisation rates were lower in schizophrenia (HR 0.57, 95% CI 0.48-0.67), bipolar disorder (HR 0.69, 95% CI 0.56-0.85) and major depression (HR 0.78, 95% CI 0.73-0.83). Mortality and revascularisation disparities persisted from 1991 to 2014, with absolute mortality disparities more apparent for MIs that occurred around 70 years of age, the overall mean age of MI. Women with major depression had a greater reduction in revascularisation than men with major depression. CONCLUSIONS There are sustained SMI disparities in MI intervention and prognosis. There is an urgent need to understand and tackle the reasons for these disparities.
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Affiliation(s)
- Kelly Fleetwood
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stewart W Mercer
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Kirsty Licence
- Information Services Division, National Services Scotland, NHS Scotland, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Caroline A Jackson
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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14
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Sreenivasan J, Khan MS, Khan SU, Hooda U, Aronow WS, Panza JA, Levine GN, Commodore-Mensah Y, Blumenthal RS, Michos ED. Mental health disorders among patients with acute myocardial infarction in the United States. Am J Prev Cardiol 2021; 5:100133. [PMID: 34327485 PMCID: PMC8315415 DOI: 10.1016/j.ajpc.2020.100133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the prevalence, temporal trends and sex- and racial/ethnic differences in the burden of mental health disorders (MHD) and outcomes among patients with myocardial infarction (MI) in the United States. METHODS Using the National Inpatient Sample Database, we evaluated a contemporary cohort of patients hospitalized for acute MI in the United States over 10 years period from 2008 to 2017. We used multivariable logistic regression analysis for in-hospital outcomes, yearly trends and estimated annual percent change (APC) in odds of MHD among MI patients. RESULTS We included a total sample of 6,117,804 hospitalizations for MI (ST elevation MI in 30.4%), with a mean age of 67.2 ± 0.04 years and 39% females. Major depression (6.2%) and anxiety disorders (6.0%) were the most common MHD, followed by bipolar disorder (0.9%), schizophrenia/psychotic disorders (0.8%) and post-traumatic stress disorder (PTSD) (0.3%). Between 2008 and 2017, the prevalences significantly increased for major depression (4.7%-7.4%, APC +6.2%, p < .001), anxiety disorders (3.2%-8.9%, APC +13.5%, p < .001), PTSD (0.2%-0.6%, +12.5%, p < .001) and bipolar disorder (0.7%-1.0%, APC +4.0%, p < .001). Significant sex- and racial/ethnic-differences were also noted. Major depression, bipolar disorder or schizophrenia/psychotic disorders were associated with a lower likelihood of coronary revascularization. CONCLUSION MHD are common among patients with acute MI and there was a concerning increase in the prevalence of major depression, bipolar disorder, anxiety disorders and PTSD over this 10-year period. Focused mental health interventions are warranted to address the increasing burden of comorbid MHD among acute MI.
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Affiliation(s)
- Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | | | - Safi U. Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Urvashi Hooda
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Julio A. Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Glenn N. Levine
- Division of Cardiology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Hauck TS, Liu N, Wijeysundera HC, Kurdyak P. Mortality and Revascularization among Myocardial Infarction Patients with Schizophrenia: A Population-Based Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:454-462. [PMID: 32013569 PMCID: PMC7298580 DOI: 10.1177/0706743720904845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. AIMS To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. METHOD This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. RESULTS A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophrenia patients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). CONCLUSIONS In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.
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Affiliation(s)
- Tanya S. Hauck
- Department of Psychiatry, Centre for Addiction and Mental Health,
University of Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
| | - Ning Liu
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
| | - Harindra C. Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
- Department of Medicine, Schulich Heart Centre, Sunnybrook Research
Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Centre for Addiction and Mental Health,
University of Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
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16
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Chang WC, Chan JKN, Wong CSM, Hai JSH, Or PCF, Chen EYH. Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Psychotic Disorders: A Population-Based Cohort Study. Schizophr Bull 2020; 46:774-784. [PMID: 32083305 PMCID: PMC7342096 DOI: 10.1093/schbul/sbaa013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ischemic heart disease is the leading cause of mortality in psychotic disorders. There is a paucity of research comprehensively evaluating short-term mortality, cardiovascular complications, and treatment inequality after cardiac events in patients with psychotic disorders. This population-based cohort study examined 30-day and 1-year all-cause mortality, cardiovascular complication rates, 30-day and 1-year receipt of invasive cardiac procedures, and 90-day post-discharge cardioprotective medication treatment following admission for first-recorded acute coronary syndrome (ACS) among patients with psychotic disorders (n = 703) compared with patients without psychotic disorders (n = 66 989) between January 2006 and December 2016 in Hong Kong (HK). Study data were retrieved from territory-wide medical record database of public healthcare services to 7.5 million HK residents. Multivariate regression analyses (ORs and 95% CIs), adjusting for demographics and medical comorbidities, were conducted to evaluate associations between psychotic disorders and post-ACS outcomes. Our results showed that patients with psychotic disorders had higher 30-day (OR: 1.99 [95% CI: 1.65-2.39]) and 1-year (2.13 [1.79-2.54]) mortality, and cardiovascular complication rates (1.20 [1.02-1.41]), lower receipt of cardiac catheterization (30-d: 0.54 [0.43-0.68]; 1-y: 0.46 [0.38-0.56]), percutaneous coronary intervention (30-d: 0.55 [0.44-0.70]; 1-y: 0.52 [0.42-0.63]) and reduced β-blockers (0.81 [0.68-0.97]), statins (0.54 [0.44-0.66]), and clopidogrel prescriptions (0.66 [0.55-0.80]). Associations between psychotic disorder and increased mortality remained significant even after complications and treatment receipt were additionally adjusted. Our findings indicate that psychotic disorders are associated with increased risks of short-term post-ACS mortality, cardiovascular complications, and inferior treatment. Excess mortality is not substantially explained by treatment inequality. Further investigation is warranted to clarify factors for suboptimal cardiac-care and elevated mortality in psychotic disorders to enhance post-ACS outcome.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,To whom correspondence should be addressed; Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: 852-22554486, fax: 852-28551345, e-mail:
| | - Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - JoJo Siu Han Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Philip Chi Fai Or
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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17
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Heiberg IH, Nesvåg R, Balteskard L, Bramness JG, Hultman CM, Næss Ø, Reichborn‐Kjennerud T, Ystrom E, Jacobsen BK, Høye A. Diagnostic tests and treatment procedures performed prior to cardiovascular death in individuals with severe mental illness. Acta Psychiatr Scand 2020; 141:439-451. [PMID: 32022895 PMCID: PMC7317477 DOI: 10.1111/acps.13157] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine whether severe mental illnesses (i.e., schizophrenia or bipolar disorder) affected diagnostic testing and treatment for cardiovascular diseases in primary and specialized health care. METHODS We performed a nationwide study of 72 385 individuals who died from cardiovascular disease, of whom 1487 had been diagnosed with severe mental illnesses. Log-binomial regression analysis was applied to study the impact of severe mental illnesses on the uptake of diagnostic tests (e.g., 24-h blood pressure, glucose/HbA1c measurements, electrocardiography, echocardiography, coronary angiography, and ultrasound of peripheral vessels) and invasive cardiovascular treatments (i.e., revascularization, arrhythmia treatment, and vascular surgery). RESULTS Patients with and without severe mental illnesses had similar prevalences of cardiovascular diagnostic tests performed in primary care, but patients with schizophrenia had lower prevalences of specialized cardiovascular examinations (prevalence ratio (PR) 0.78; 95% CI 0.73-0.85). Subjects with severe mental illnesses had lower prevalences of invasive cardiovascular treatments (schizophrenia, PR 0.58; 95% CI 0.49-0.70, bipolar disorder, PR 0.78; 95% CI 0.66-0.92). The prevalence of invasive cardiovascular treatments was similar in patients with and without severe mental illnesses when cardiovascular disease was diagnosed before death. CONCLUSION Better access to specialized cardiovascular examinations is important to ensure equal cardiovascular treatments among individuals with severe mental illnesses.
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Affiliation(s)
- I. H. Heiberg
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway
| | - R. Nesvåg
- Norwegian Medical AssociationOsloNorway,Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway
| | - L. Balteskard
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway
| | - J. G. Bramness
- Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersInnlandet Hospital TrustHamarNorway
| | - C. M. Hultman
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Icahn School of MedicineMt Sinai HospitalNew YorkNYUSA
| | - Ø. Næss
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Institute of Health and SocietyUniversity of OsloOsloNorway
| | - T. Reichborn‐Kjennerud
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
| | - E. Ystrom
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway,Department of PsychologyPROMENTA Research CenterUniversity of OsloOsloNorway,PharmacoEpidemiology and Drug Safety Research GroupSchool of PharmacyUniversity of OsloOsloNorway
| | - B. K. Jacobsen
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway,Department of Community MedicineUiT – The Arctic University of NorwayTromsøNorway,Department of Community MedicineCentre for Sami Health ResearchUiT – The Arctic University of NorwayTromsøNorway
| | - A. Høye
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway,Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway,Division of Mental Health and Substance AbuseUniversity Hospital of North NorwayTromsøNorway
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18
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Shao M, Zhuo C, Gao X, Chen C, Xu Y, Tian H, Li G, Jiang D, Wang W. Reduced rate of revascularization in schizophrenic patients with acute myocardial infarction: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109870. [PMID: 31954758 DOI: 10.1016/j.pnpbp.2020.109870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/16/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
IMPORTANCE It has been suggested that patients with schizophrenia have higher than expected mortality following acute coronary events. However, the in-hospital revascularization rate in patients with schizophrenia and acute myocardial infarction (AMI) compared to mentally healthy patients remains unknown. OBJECTIVE To evaluate the revascularization rate in schizophrenic patients after AMI with a meta-analysis of observational studies. DATA SOURCES PubMed and Embase electronical databases. STUDY SELECTION Observational studies that evaluate the likelihood of revascularization in AMI patients with schizophrenia compared to those without schizophrenia, after adjustment for potential influencing factors. DATA EXTRACTION AND SYNTHESIS Data regarding study design, characteristics of the AMI patients and schizophrenic patients, and strategies of revascularization were extracted. Results were pooled and analyzed with a random effect model to incorporate the potential heterogeneity. MAIN OUTCOME AND MEASURES The likelihood of revascularization in AMI patients with schizophrenia compared to those without schizophrenia, after adjustment for potential influencing factors. RESULTS Overall, 3,260,754 hospitalized AMI patients from six follow-up studies were included, of which 17,875 patients had a prior diagnosis of schizophrenia. Results of this meta-analysis suggest that revascularization was significantly lower in AMI patients with schizophrenia compared to those without schizophrenia (odds ratio [OR]: 0.48, 95% confidence interval [CI]: 0.38 to 0.62, p < .001; I2 = 93%), after adjustment for demographic characteristics, comorbidities, and hospital and regional factors. Specifically, AMI patients with schizophrenia had significantly fewer percutaneous coronary interventions (OR: 0.48, 95% CI: 0.41 to 0.56, p < .001; I2 = 49%) and coronary artery bypass grafts (OR: 0.61, 95% CI: 0.53 to 0.70, p < .001; I2 = 20%) compared to those without schizophrenia. CONCLUSIONS AND RELEVANCE Patients with schizophrenia and AMI have a lower rate of coronary revascularization as compared with patients without schizophrenia, which is an important cause of higher-than-expected mortality rate in this population.
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Affiliation(s)
- Mingjing Shao
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Chuanjun Zhuo
- Department of psychiatry, School of Mental Health, Jining University, Jining, 27211, Shandong Province, China; Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou 325000, China; Psychiatric-Neuroimging-Genetics and Comorbidity Laboratory (PNGC-Lab), Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin 300222, China; Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan 030001, China; Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital and University of Alberta, Xiamen Xianyue Hospital, Xiamen 361000, China.
| | - Xiangyang Gao
- Center for Health Statistics, Big data center of chronic disease, Health Management Institute, 301 Hospital of Chinese People's Liberation Army, General Hospital of Chinese People's Liberation Army, 100191 Beijing, China
| | - Ce Chen
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou 325000, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Hongjun Tian
- Psychiatric-Neuroimging-Genetics and Comorbidity Laboratory (PNGC-Lab), Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin 300222, China
| | - Gongying Li
- Department of psychiatry, School of Mental Health, Jining University, Jining, 27211, Shandong Province, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou 325000, China
| | - Wenqiang Wang
- Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital and University of Alberta, Xiamen Xianyue Hospital, Xiamen 361000, China
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Dregan A, McNeill A, Gaughran F, Jones PB, Bazley A, Cross S, Lillywhite K, Armstrong D, Smith S, Osborn DPJ, Stewart R, Wykes T, Hotopf M. Potential gains in life expectancy from reducing amenable mortality among people diagnosed with serious mental illness in the United Kingdom. PLoS One 2020; 15:e0230674. [PMID: 32218598 PMCID: PMC7100972 DOI: 10.1371/journal.pone.0230674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To estimate the potential gain in life expectancy from addressing modifiable risk factors for all-cause mortality (excluding suicide and deaths from accidents or violence) across specific serious mental illness (SMI) subgroups, namely schizophrenia, schizoaffective disorders, and bipolar disorders in a Western population. METHODS We have used relative risks from recent meta-analyses to estimate the population attribution fraction (PAF) due to specific modifiable risk factors known to be associated with all-cause mortality within SMI. The potential gain in life expectancy at birth, age 50 and age 65 years were assessed by estimating the combined effect of modifiable risk factors from different contextual levels (behavioural, healthcare, social) and accounting for the effectiveness of existing interventions tackling these factors. Projections for annual gain in life expectancy at birth during a two-decade was estimated using the Annual Percentage Change (APC) formula. The predicted estimates were based on mortality rates for year 2014-2015. RESULTS Based on the effectiveness of existing interventions targeting these modifiable risk factors, we estimated potential gain in life expectancy at birth of four (bipolar disorders), six (schizoaffective disorders), or seven years (schizophrenia). The gain in life expectancy at age 50 years was three (bipolar disorders) or five (schizophrenia and schizoaffective disorders) years. The projected gain in life expectancy at age 65 years was three (bipolar disorders) or four (schizophrenia and schizoaffective disorders) years. CONCLUSIONS The implementation of existing interventions targeting modifiable risk factors could narrow the current mortality gap between the general and the SMI populations by 24% (men) to 28% (women). These projections represent ideal circumstances and without the limitation of overestimation which often comes with PAFs.
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Affiliation(s)
- Alex Dregan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Anna Bazley
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Sean Cross
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Kate Lillywhite
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - David Armstrong
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Shubulade Smith
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
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20
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Shao M, Tian H, Wang L, Jiang D, Ji F, Zhuo C. Mortality risk following acute coronary syndrome among patients with schizophrenia: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109737. [PMID: 31442555 DOI: 10.1016/j.pnpbp.2019.109737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/04/2019] [Accepted: 08/18/2019] [Indexed: 12/14/2022]
Abstract
Patients with schizophrenia have a higher incidence of coronary artery disease. This meta-analysis was performed to evaluate the influence of a prior diagnosis of schizophrenia on mortality following acute coronary syndrome (ACS). Relevant longitudinal follow-up studies were obtained via systematic search of PubMed and Embase databases. A random effect model was used to perform the meta-analysis. This meta-analysis included 3,611,343 hospitalized patients with ACS from nine follow-up studies. The results show that, in patients with schizophrenia, ACS was associated with a significantly higher risk of mortality (multivariate adjusted risk ratio [RR]: 1.66, p < .001) with significant heterogeneity (I2 = 93%) compared to the results of mentally healthy patients. Subgroup analyses demonstrated that patients with schizophrenia were associated with higher ACS mortality within one month (RR: 1.68, p < .001) and during a follow-up period of ≥one year (RR: 1.71, p = .01), in studies with (RR: 1.65, p = .06) and without the adjustment of revascularization treatments (RR: 1.68, p = .004), as compared with the results of mentally healthy patients. These results indicate that patients with schizophrenia have a higher than expected mortality risk in the case of acute coronary events.
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Affiliation(s)
- Mingjing Shao
- National Integrated Traditional and Western Medicine Center for Cardivascular Disease, China-Japan Friendship Hospital, Beijing 100101, China
| | - Hongjun Tian
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China
| | - Lina Wang
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou 325000, China
| | - Feng Ji
- Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining 272191, China
| | - Chuanjun Zhuo
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China; Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou 325000, China; Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining 272191, China; Department of China, Canada Biological Psychiatry Lab, Xiamen Xianyue Hospital, Xiamen 361000, China; Department of Psychiatry, College of Basic Medical Research, Tianjin Medical University, Tianjin 300000, China.
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21
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Barcella CA, Mohr GH, Kragholm K, Blanche P, Gerds TA, Wissenberg M, Hansen SM, Bundgaard K, Lippert FK, Folke F, Torp-Pedersen C, Kessing LV, Gislason GH, Søndergaard KB. Out-of-hospital cardiac arrest in patients with psychiatric disorders — Characteristics and outcomes. Resuscitation 2019; 143:180-188. [DOI: 10.1016/j.resuscitation.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/20/2019] [Accepted: 07/06/2019] [Indexed: 01/08/2023]
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22
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Barcella CA, Mohr GH, Kragholm KH, Gerds TA, Jensen SE, Polcwiartek C, Wissenberg M, Lippert FK, Torp-Pedersen C, Kessing LV, Gislason GH, Søndergaard KB. Out-of-Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter-Defibrillator and Survival. J Am Heart Assoc 2019; 8:e012708. [PMID: 31423870 PMCID: PMC6759883 DOI: 10.1161/jaha.119.012708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Healthcare disparities for psychiatric patients are common. Whether these inequalities apply to postresuscitation management in out‐of‐hospital cardiac arrest (OHCA) is unknown. We investigated differences in in‐hospital cardiovascular procedures following OHCA between patients with and without psychiatric disorders. Methods and Results Using the Danish nationwide registries, we identified patients admitted to the hospital following OHCA of presumed cardiac cause (2001‐2015). Psychiatric disorders were identified using hospital diagnoses or redeemed prescriptions for psychotropic drugs. We calculated age‐ and sex‐standardized incidence rates and incidence rate ratios (IRRs) of cardiovascular procedures during post‐OHCA admission in patients with and without psychiatric disorders. Differences in 30‐day and 1‐year survival were assessed by multivariable logistic regression in the overall population and among 2‐day survivors who received acute coronary angiography (CAG). We included 7288 hospitalized patients who had experienced an OHCA: 1661 (22.8%) had a psychiatric disorder. Compared with patients without psychiatric disorders, patients with psychiatric disorders had lower standardized incidence rates for acute CAG (≤1 day post‐OHCA) (IRR, 0.51; 95% CI, 0.45–0.57), subacute CAG (2–30 days post‐OHCA) (IRR, 0.40; 95% CI, 0.30–0.52), and implantable cardioverter‐defibrillator implantation (IRR, 0.67; 95% CI, 0.48–0.95). Conversely, we did not detect differences in coronary revascularization among patients undergoing CAG (IRR, 1.11; 95% CI, 0.94–1.30). Patients with psychiatric disorders had lower survival even among 2‐day survivors who received acute CAG: (odds ratio of 30‐day survival, 0.68; 95% CI, 0.52–0.91; and 1‐year survival, 0.66; 95% CI, 0.50–0.88). Conclusions Psychiatric patients had a lower probability of receiving post‐OHCA CAG and implantable cardioverter‐defibrillator implantation compared with nonpsychiatric patients but the same probability of coronary revascularization among patients undergoing CAG. However, their survival was lower irrespective of angiographic procedures.
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Affiliation(s)
- Carlo Alberto Barcella
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark
| | - Grimur Høgnason Mohr
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Psychiatric Center Amager Copenhagen University Hospital Copenhagen Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Health Science and Technology Aalborg University Aalborg Denmark.,Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark
| | - Thomas Alexander Gerds
- Department of Biostatistics University of Copenhagen Denmark.,The Danish Heart Foundation Copenhagen Denmark
| | - Svend Eggert Jensen
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark
| | - Mads Wissenberg
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Emergency Medical Services The Capital Region of Denmark Copenhagen Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen Copenhagen University Hospital Copenhagen Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,The Danish Heart Foundation Copenhagen Denmark
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23
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Kaur G, Schulman-Marcus J. The Challenge of Myocardial Infarction in Patients With Mental Illness. Can J Cardiol 2019; 35:797-798. [DOI: 10.1016/j.cjca.2019.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 11/27/2022] Open
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Mohamed MO, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas MA. Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations. Can J Cardiol 2019; 35:821-830. [PMID: 31292080 DOI: 10.1016/j.cjca.2019.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI). METHODS All AMI hospitalizations from the National Inpatient Sample were included, stratified by mental health status into 5 groups: no SMI, schizophrenia, other non-organic psychoses (ONOP), bipolar disorder, and major depression. Regression analyses were performed to assess the association (adjusted odds ratios [ORs], P ≤ 0.001 for all outcomes) between SMI subtypes and clinical outcomes. RESULTS Of 6,968,777 AMI hospitalizations between 2004 and 2014, 439,544 patients (6.5%) had an SMI diagnosis. Although patients with schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared with those without SMI, only schizophrenic patients were at increased odds of mortality (OR, 1.10; 95% confidence interval [CI], 1.04-1.16), whereas ONOP was the only group at increased odds of stroke (OR, 1.53; 95% CI, 1.42-1.65) after multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared with those without SMI (OR, 1.11; 95% CI, 1.04-1.17). All those with SMI subtypes were less likely to receive coronary angiography and percutaneous coronary intervention, with the schizophrenia group being at least odds of either procedure (OR, 0.46; 95% CI, 0.45-0.48 and OR, 0.57; 95% CI, 0.55-0.59, respectively). CONCLUSION Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population.
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Affiliation(s)
- Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Saeed Farooq
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Nishat Siddiqui
- Nevill Hall Hospital, Aneurin Bevan University Health Board, Wales, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ritu Thamman
- Department of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona, USA
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
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Kugathasan P, Horsdal HT, Aagaard J, Jensen SE, Laursen TM, Nielsen RE. Association of Secondary Preventive Cardiovascular Treatment After Myocardial Infarction With Mortality Among Patients With Schizophrenia. JAMA Psychiatry 2018; 75:1234-1240. [PMID: 30422158 PMCID: PMC6583028 DOI: 10.1001/jamapsychiatry.2018.2742] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Cardioprotective medication use is an important secondary preventive treatment after cardiovascular events. Patients with schizophrenia have excess cardiovascular morbidity and mortality, but no studies have investigated whether taking recommended cardioprotective medication can reduce this excess mortality. OBJECTIVE To assess the association of exposure to secondary cardiovascular treatment with all-cause mortality after myocardial infarction among patients with schizophrenia compared with the general population. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study included individuals admitted with first-time myocardial infarction in Denmark from January 1, 1995, to December 31, 2015. The cohort was dichotomously divided by a diagnosis of schizophrenia. Data on the prescription of guideline-recommended cardioprotective medication, including antithrombotics, β-blockers, vitamin K antagonist, angiotensin-converting enzyme inhibitors, and statins, were obtained from the nationwide registries. EXPOSURES Time exposed to cardioprotective medication. MAIN OUTCOMES AND MEASURE Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% CIs for the association between treatment exposure and all-cause mortality after myocardial infarction between patients with and without schizophrenia. RESULTS The cohort included 105 018 patients with myocardial infarction, including 684 patients with schizophrenia (0.7%; 483 male [70.6%]; mean [SD] age at diagnosis, 57.3 [10.6] years) and 104 334 general population patients (99.3%; 73 454 male [70.4%]; mean [SD] age at diagnosis, 61.0 [10.6] years), with a total follow-up of 796 435 person-years and 28 059 deaths. Patients diagnosed with schizophrenia who did not receive cardioprotective treatment had the highest mortality rate (HR, 8.78; 95% CI, 4.37-17.64) compared with the general population treated, with treated patients diagnosed with schizophrenia having an increased HR of 1.97 (95% CI, 1.25-3.10). The analyses of the associations of different cardiac therapy strategies with mortality rates revealed that patients with schizophrenia who were treated with any combination of triple therapy had mortality rates similar to those observed in the general population (HR, 1.05; 95% CI, 0.43-2.52) in the multivariable analysis. CONCLUSIONS AND RELEVANCE Cardioprotective medication after myocardial infarction should be carefully managed to improve prognosis. The study results suggest that some of the increased cardiac mortality among patients with schizophrenia can be reduced if these patients are efficiently administered combinations of secondary preventive treatments after cardiac events.
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Affiliation(s)
- Pirathiv Kugathasan
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Jørgen Aagaard
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark
| | - René Ernst Nielsen
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Van Damme A, Vanderheeren P, De Backer T, Desimpel F. Atypical presentation of acute coronary syndrome (ACS): a case report. Acta Clin Belg 2018; 73:453-459. [PMID: 29623770 DOI: 10.1080/17843286.2018.1460019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
CASE A 45-year-old man presented at the emergency department (ED) with stomach pain since eight days. The patient was not worried about his symptoms and requested only pain relief. The emergency physician requested a consult of the gastroenterologist. Clinical examination was unremarkable. However, 12-lead ECG and ischemic markers were suggestive of acute coronary syndrome (ACS) which led to admission at the cardiology department. Despite delayed presentation, the patient was still referred for urgent coronary angiogram after receiving heparin, ticagrelor and acetylsalicylic acid because of persistent pain. An acute occlusion of the posterior descending artery was visualized and a percutaneous coronary intervention (PCI) with implantation of a drug-eluting stent was performed. DISCUSSION Atypical presentation of ACS can range from non-chest pain to an epileptic seizure. Risk factors for atypical presentation include female gender, old age, comorbidities and severe mental illness. Troponin testing plays a central role when confronted with ACS but has only limited added-value with non-chest pain ACS. In cohort studies 1-2.2% of diagnosis of ACS is missed by emergency physicians. Possible explanations include atypical symptoms, non-diagnostic ECG and failure to interpret subtle ECG changes. ACS without chest pain frequently gets underdiagnosed and undertreated, which leads to more complications and a higher in-hospital mortality rate.
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Affiliation(s)
- Axel Van Damme
- Faculty of Medicine and Health Sciences,Ghent University, Ghent, Belgium
| | | | - Tine De Backer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Kugathasan P, Laursen TM, Grøntved S, Jensen SE, Aagaard J, Nielsen RE. Increased long-term mortality after myocardial infarction in patients with schizophrenia. Schizophr Res 2018; 199:103-108. [PMID: 29555214 DOI: 10.1016/j.schres.2018.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ischemic heart disease increases mortality in patients with schizophrenia. This nationwide study explored short-term and long-term mortality rates in patients with schizophrenia experiencing myocardial infarction (MI) compared to controls from the general population experiencing MI, as well as patients with schizophrenia and people from the general population not experiencing MI. METHOD A Danish nationwide cohort study including incident patients diagnosed with schizophrenia between 1980 and 2015, matched 1:5 on year of birth and gender to controls from the general population. Primary outcome was all-cause mortality. Data were analysed utilizing Cox regression models, Kaplan-Meier estimates and standardized mortality ratios (SMR). RESULTS Patients with schizophrenia experiencing MI had an increased mortality rate (Hazard rate ratio (HR) 9.94, 95%CI(8.71-11.35)), as well as schizophrenia controls (HR 4.50, 95%CI(4.36-4.64)) and MI controls (HR 3.27, 95%CI(3.03-3.52)) with controls not experiencing MI serving as reference in a model adjusted for age at entry, gender and calendar year. No difference in 30-day mortality was observed between groups experiencing MI, but increased mortality rates were shown in patients with schizophrenia at 1-year and 5-year follow-up. Trends in SMR declined in MI controls, while patients with schizophrenia showed an unchanged SMR over time. CONCLUSIONS Patients with schizophrenia have not experienced a decline in mortality rate following MI compared to the general population in long-term follow-up. This finding highlights the need for research in MI follow-up care for patients with schizophrenia.
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Affiliation(s)
- Pirathiv Kugathasan
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Simon Grøntved
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jørgen Aagaard
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - René Ernst Nielsen
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Campi TR, George S, Villacís D, Ward-Peterson M, Barengo NC, Zevallos JC. Effect of charted mental illness on reperfusion therapy in hospitalized patients with an acute myocardial infarction in Florida. Medicine (Baltimore) 2017; 96:e7788. [PMID: 28834883 PMCID: PMC5572005 DOI: 10.1097/md.0000000000007788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with mental illness carry risk factors that predispose them to excess cardiovascular mortality from an acute myocardial infarction (AMI) compared to the general population. The aim of this study was to determine if patients with AMI and charted mental illness (CMI) received less reperfusion therapy following an AMI, compared to AMI patients without CMI in a recent sample population from Florida.A secondary analysis of data was conducted using the Florida Agency for Health Care Administration (FL-AHCA) hospital discharge registry. Adults hospitalized with an AMI from 01/01/2010 to 12/31/2015 were included for the analysis. The dependent variable was administration of reperfusion therapy (thrombolytic, percutaneous coronary intervention [PCI], and coronary artery bypass graft [CABG]), and the independent variable was the presence of CMI (depression, schizophrenia, and bipolar disorder). Multivariate logistic regression models were used to test the association controlling for age, gender, ethnicity, race, health insurance, and comorbidities.The database included 61,614 adults (31.3% women) hospitalized with AMI in Florida. The CMI population comprised of 1036 patients (1.7%) who were on average 5 years younger than non-CMI (60.2 ±12.8 versus 65.2 ±14.1; P < .001). Compared with patients without CMI, patients with CMI had higher proportions of women, governmental health insurance holders, and those with more comorbidities. The adjusted odds ratio indicated that patients with CMI were 30% less likely to receive reperfusion therapy compared with those without CMI (OR = 0.7; 95% CI = 0.6-0.8). Within the AMI population including those with and without CMI, women were 23% less likely to receive therapy than men; blacks were 26% less likely to receive reperfusion therapy than whites; and those holding government health insurances were between 20% and 40% less likely to receive reperfusion therapy than those with private health insurance.Patients with AMI and CMI were statistically significantly less likely to receive reperfusion therapy compared with patients without CMI. These findings highlight the need to implement AMI management care aimed to reduce disparities among medically vulnerable patients (those with CMI, women, blacks, and those with governmental health insurance).
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Affiliation(s)
- Thomas R. Campi
- American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda
| | - Sharon George
- American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda
| | - Diego Villacís
- Universidad de las Américas, Facultad de Medicina, Quito, Ecuador
| | - Melissa Ward-Peterson
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Noël C. Barengo
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Juan C. Zevallos
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
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Zolezzi M, Abdulrhim S, Isleem N, Zahrah F, Eltorki Y. Medical comorbidities in patients with serious mental illness: a retrospective study of mental health patients attending an outpatient clinic in Qatar. Neuropsychiatr Dis Treat 2017; 13:2411-2418. [PMID: 28979128 PMCID: PMC5608084 DOI: 10.2147/ndt.s141448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The life span of individuals with serious mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. The aim of the study was to investigate the prevalence rates of different physical illnesses in individuals with SMI and to examine how these are being managed. METHODS The study was a cross-sectional retrospective chart review of a cohort of patients with SMI. A comprehensive electronic data extraction tool using SurveyMonkey® was used to collect patient demographics, psychiatric and medical comorbidities, medications and all relevant physical assessments. Data were then first extrapolated into an Excel® spreadsheet and later to SPSS® for data analysis. A descriptive statistical approach was used to analyze the demographic and clinical data. Chi-square test for categorical variables and t-test for continuous variables were used to compare the demographic and clinical characteristics of the cohort. RESULTS A total of 336 patients with SMI were included for the retrospective chart review. The majority of these patients had a diagnosis of depression (50.3%), followed by schizophrenia (33.0%) and bipolar disorder (19.6%). Diabetes was the most frequent medical comorbidity, diagnosed in 16.1% of SMI patients, followed by hypertension (9.2%) and dyslipidemia (9.8%). Monitoring of comorbidity-associated risk factors and other relevant physical assessment parameters (such as blood pressure, weight, hemoglobin A1c [HbA1c], blood glucose and lipids) were documented in less than 50% of patients, and some parameters, such as smoking status, were not documented at all. CONCLUSION Both, the literature and our cohort provide evidence that individuals with SMI are less likely to receive standard levels of care for their medical comorbidities.
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Affiliation(s)
| | | | | | | | - Yassin Eltorki
- Department of Pharmacy, Hamad Medical Corporation Mental Health Hospital, Doha, Qatar
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Affiliation(s)
- Lisa Rosenbaum
- Dr. Rosenbaum is a national correspondent for the Journal
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Schulman-Marcus J, Shah T, Swaminathan RV, Feldman DN, Wong SC, Singh HS, Minutello RM, Bergman G, Kim LK. Comparison of Recent Trends in Patients With and Without Major Depression and Acute ST-Elevation Myocardial Infarction. Am J Cardiol 2016; 118:779-784. [PMID: 27453511 DOI: 10.1016/j.amjcard.2016.06.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Abstract
Depression has been associated with adverse outcomes after acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). However, trends over time in the incidence and inhospital treatment of STEMI for patients with co-morbid depression in the current era are unknown. We conducted a serial, cross-sectional analysis of patients with STEMI (weighted n = 3,057,998) in the National Inpatient Sample from 2003 to 2012. We examined trends in STEMI incidence and percutaneous coronary intervention (PCI) for patients with and without depression. We used multivariate logistic regression to assess observed differences and to explore trends in inhospital mortality. Depression was present in 153,180 (5%) of the sample. Patients with depression were more likely to be female (55% vs 37%), of white race (86% vs 78%), and had lower crude mortality (12.0% vs 14.2%; p <0.001 for all). Over time, STEMI incidence decreased 52% in patients without depression (p for trend <0.001) but remained stable in those with depression (p for trend 0.74). Although the use of PCI increased in all subgroups over the study duration (p for trend <0.001), depression was associated with lower adjusted odds of PCI (odds ratio 0.90, 95% confidence interval 0.89 to 0.92, p <0.001). In conclusion, in contrast to the wider population, the incidence of STEMI is not decreasing in patients with co-morbid depression. Patients with STEMI and co-morbid depression are less likely to receive revascularization therapy with PCI. These concerning differences warrant further attention.
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Affiliation(s)
- Joshua Schulman-Marcus
- Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York.
| | - Tara Shah
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Rajesh V Swaminathan
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Dmitriy N Feldman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Shing-Chiu Wong
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Harsimran S Singh
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Robert M Minutello
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Geoffrey Bergman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Luke K Kim
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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