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 patientrelated factors.
Sepsis-induced cardiomyopathy has been increasingly recognized; however, the prevalence and impact of sepsis in peripartum cardiomyopathy (PPCM) patients need further exploration. We aimed to assess the burden and outcomes of PPCMrelated hospitalization with vs. without sepsis in this population-based study in the United States. METHODS:We queried the National Inpatient Sample (2015October-2017) to access PPCM with vs. without sepsis using relevant ICD-10 codes. We compared baseline demographics and comorbidities between the groups (sepsisþ vs. sepsis-). The primary outcomes included all-cause mortality, cardiac arrest including ventricular tachyarrhythmias, cardiogenic shock, respiratory failure, mechanical ventilation/respiratory intubation, and secondary outcomes included patient disposition, length of stay, and hospital charges. A two-tailed p-value<0.05 was considered for statistical significance.RESULTS: Of the 10,275 PPCM admissions, 460 were related to sepsis (0.04%). The PPCM-sepsisþ cohort often consisted of younger (30 [24-36]), white (47.1% vs 39%, p<0.001) patients admitted non-electively (90.2% vs 87.7%, p¼0.109) compared to the PPCM-sepsis-cohort. The PPCM-sepsisþ cohort more frequently comprised of Medicaid enrollees (52.2% vs 51.9%, p<0.001), patients in middle income quartile (27.2% vs 26.0%, p¼0.007), admissions to large bedsized hospitals (64.1% vs 62%, p¼0.588) compared to PPCM-sepsis -cohort. The PPCM-sepsisþ cohort was often associated with congestive heart failure (55.4% vs 48.2%, p¼0.003), coagulopathy (10.9% vs 6.4%, p<0.001), chronic kidney disease (15.2% vs 5.9%, p<0.001), anemias (27.2% vs 20.8%, p<0.001), pulmonary circulation disorder (3.3% vs 1.7%, p¼0.012), and psychoses (4.3% vs 1.9%, p<0.001) compared to PPCM-sepsis-cohort. PPCM-sepsisþ cohort showed lower frequency of hypertension (40.2% vs 59.9%, p<0.001), obesity (16.3% vs 26.3%, p<0.001), chronic pulmonary disease (8.7% vs 14.9%, p<0.001) and valvular heart disease (7.6% vs 13.0%, p<0.001) compared to sepsis-cohort. The PPCM-sepsisþ cohort had significantly higher frequency and odds of all-cause mortality (7.6% vs 1.2%, aOR 7.59, 95% CI 4.35-13.23; p<0.001) along with higher rates of cardiac arrest (5.4% vs 3.0%, p0.003), cardiogenic shock (8.7% vs 5.2%, p<0.001), respiratory failure (56.5% vs 19.8%, p<0.001), mechanical ventilation/respiratory intubation (28.3% vs 10.9%, p<0.001) compared to the PPCM-sepsis-cohort. The PPCM-sepsisþ cohort were less often discharged routinely (63.0% vs. 81.5%, p<0.001), experienced prolonged hospital stay (5 vs 3 days) and higher hospital charges (60,752$ vs 30,554$) as compared to PPCM-sepsis-cohort (p<0.001). CONCLUSIONS:The frequency of sepsis in PPCM-related admissions remains low. However, concomitant sepsis predicted nearly seven times higher all-cause mortality and alarmingly higher rates of cardiopulmonary complications in PPCM. Preventive screening measures and timely management of sepsis in PPCM could prevent worse outcomes.CLINICAL IMPLICATIONS: Sepsis in PPCM patients leads to si...
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