How does a history of psychiatric hospital care influence access to coronary care: a cohort study

Abstract

ObjectivesEquity in physical health of patients with severe mental disorders is a major public health concern. The aim of this cohort study was to examine equity in access to coronary care among persons with a history of severe mental disorder in 1998–2009.DesignNationwide register linkage cohort study.SettingHospital care in the Finnish healthcare system.PopulationThe study population consisted of all residents in Finland aged 40 years or older. All hospital discharges in 1998–2009 with a diagnosis of coronary heart disease or severe mental disorder were obtained from the Care Register.Primary outcome measuresData on deaths, hospitalisations and coronary revascularisations were linked to the data set using unique personal identifiers.ResultsPatients with severe mental disorders had increased likelihood of hospital care due to coronary heart disease (RR between 1.22, 95% CI 1.18 to 1.25 and 1.93, 1.84 to 2.03 in different age groups) and in 40–49-year-olds also increased likelihood of revascularisation (1.26, 1.16 to 1.38) compared with persons without mental disorders. Access to revascularisation was poorer among older persons with severe mental disorders in relation to need suggested by increased coronary mortality. In spite of excess coronary mortality (ranging from 0.95, 0.89 to 1.01 to 3.16, 2.82 to 3.54), worst off were people with a history of psychosis, who did not have increased use of hospital care and had lower likelihood of receiving revascularisations (ranging from 0.44, 0.37 to 0.51 to 0.74, 0.59 to 0.93) compared with persons without mental disorders.ConclusionsSelective mechanisms seem to be at work in access to care and revascularisations among people with severe mental disorders. Healthcare professionals need to be aware of the need for targeted measures to address challenges in provision of somatic care among people with severe mental health problems, especially among people with psychoses and old people.

Cardiovascular mortality in bipolar disorder: a population-based cohort study in Sweden

“…Our results indicate a failure of the healthcare system to identify and address the health needs of those patients, which has also been shown in other studies of people with severe mental disorders 39. The levels of CVD mortality in our persons with bipolar disorder are similar to those in schizophrenia, where adverse effects of antipsychotic medication have been considered the main contributing factor.…”

Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries

“…A large number of reviews and commentaries have recently been made on the excess mortality from cardiovascular disorders in patients with schizophrenia and bipolar disorder [31]–[41]. Most studies find that cardiovascular disorder is the leading cause of death in both disorders.…”

Management of physical illness in mental health services

“…In spite of excess IHD-related mortality in this groupthere was littledifference in hospitaladmission rates forIHD betweenpsychiatricp atients andt he generalc ommunity whichw as considered to suggestadisadvantage in accesst oc area mong people with both IHD andmental disorder (34). In aFinnish study, Manderbacka et al (36) reportedthatpatients withsevere mental disorders hadi ncreasedl ikelihood of hospital care due to IHD (and in 40-49year-olds alsoincreasedlikelihood of revascularisation) comparedw ith people without mentald isorders.H owever, accesst oc arew as impaired for olderp ersons with severe mental disorders andf or people with ahistoryofpsychosis. Sullivan et al (52) reportedthat people with mentalillnesshad lowerrates of hospitalisation for diabetes than peoplewith diabetesalone.…”