Time Trends in the Use of Coronary Procedures, Guideline-Based Therapy, and All-Cause Mortality following the Acute Coronary Syndrome in Patients with Schizophrenia

Attar, Rubina; Jensen, Svend Eggert; Nielsen, René Ernst; Polcwiartek, Christoffer; Andell, Pontus; Pedersen, Christian Torp; Kragholm, Kristian

doi:10.1159/000507044

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…Increased mortality in individuals with schizophrenia appears to be associated to a large degree with comorbid physical conditions and unhealthy lifestyle behaviors. These individuals have higher rates of cardiovascular risk factors than the general population, including (components of ) metabolic syndrome 13 and diabetes 14 , as well as sedentary behavior 2 and smoking 23 , yet are less likely to receive education regarding smoking cessation and may not receive preventive or acute care for comorbid illnesses comparable to patients without schizophrenia [24][25][26][27] . Moreover, in addition to increased cardiovascular risk factors, individuals with schizophrenia also receive lower quality of care for cardiovascular disease 28 .…”

mentioning

confidence: 99%

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Correll

Solmi

Croatto³

et al. 2022

World Psychiatry

240

169

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People with schizophrenia die 15‐20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random‐effects meta‐analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all‐cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific‐cause mortality. Publication bias, subgroup and meta‐regression analyses, and quality assessment (Newcastle‐Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all‐cause mortality was increased in people with schizophrenia versus any non‐schizophrenia control group (RR=2.52, 95% CI: 2.38‐2.68, n=79), with the largest risk in first‐episode (RR=7.43, 95% CI: 4.02‐13.75, n=2) and incident (i.e., earlier‐phase) schizophrenia (RR=3.52, 95% CI: 3.09‐4.00, n=7) versus the general population. Specific‐cause mortality was highest for suicide or injury‐poisoning or undetermined non‐natural cause (RR=9.76‐8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79‐7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio‐cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All‐cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001‐0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all‐cause and suicide‐related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide‐related mortality risk in incident schizophrenia samples. All‐cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all‐cause mortality (RR=1.62, 95% CI: 1.47‐1.80, n=3). Antipsychotics were protective against all‐cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59‐0.84, n=11), with largest effects for second‐generation long‐acting injectable antipsychotics (SGA‐LAIs) (RR=0.39, 95% CI: 0.27‐0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34‐0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39‐0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44‐0.63, n=4). Antipsychotics were also protective against natural cause‐related mortality, yet first‐generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust ...

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mentioning

confidence: 99%

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Correll

Solmi

Croatto³

et al. 2022

World Psychiatry

240

169

View full text Add to dashboard Cite

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“…The prevalence rates of PAD among patients with schizophrenia in this study were higher compared to the rates in current registry-based studies. In patients with schizophrenia and incident acute myocardial infarction, 6.4% had a comorbid diagnosis of PAD (5.8% in the control group), and 11.7% of patients with schizophrenia who died of cardiovascular diseases had a diagnosis of peripheral vascular disease (20.1% among patients without severe mental illness) [15,16]. This discrepancy could be explained by an underestimation of PAD among patients with schizophrenia, for instance due to fewer diagnostic procedures.…”

Section: Prevalence Rates Of Pad and Current Literaturementioning

confidence: 99%

Peripheral artery disease in patients with schizophrenia as compared to controls

Jørgensen

Hegtmann

Straszek

et al. 2023

BMC Cardiovasc Disord

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Background Patients with schizophrenia have an increased prevalence of risk factors for peripheral artery disease (PAD) and is expected to have an increased prevalence of PAD. PAD can be detected utilizing toe–brachial index (TBI) which screens for vascular pathology proximal to the toes. Methods Using a cross-sectional design, we defined the subpopulations: (1) Patients diagnosed with schizophrenia less than 2 years before inclusion (SCZ < 2), (2) Psychiatric healthy controls matched to subpopulation 1 on sex, age, and smoking status, and (3) Patients diagnosed with schizophrenia 10 or more years before inclusion (SCZ ≥ 10). TBI was calculated by dividing toe pressures by systolic brachial blood pressure, and PAD was defined by TBI < 0.70. Logistic regression analysis with PAD as outcome and sex, age, smoking status, BMI, skin temperature, diagnosis of schizophrenia, and comorbidities as explanatory variables was conducted. Results PAD was present in 26.2% of patients diagnosed with SCZ < 2 (17 of 65) and in 18.5% of psychiatric healthy controls (12 of 65) with no statistically significant difference in prevalence rates (p = 0.29). PAD was present in 22.0% of patients diagnosed with SCZ ≥ 10 (31 of 141). In logistic regression, patients diagnosed with SCZ < 2 had an increased odds of PAD with psychiatric healthy controls as reference (Odds ratio = 2.80, 95% confidence interval 1.09–7.23, p = 0.03). The analysis was adjusted for age, sex, smoking status, BMI and comorbidities such as hypertension, diabetes and heart disease. Conclusions This study did not find statistically significant increased prevalence rates of PAD in patients with schizophrenia even though patients with SCZ were compared to psychiatric healthy controls using TBI. Utilizing logistic regression PAD was associated with schizophrenia diagnosis within the last 2 years, age and skin temperature. As PAD is initially asymptomatic, screening could be relevant in patients with schizophrenia if other risk factors are prevalent. Further large-scale multicenter studies are warranted to investigate schizophrenia as a potential risk factor for PAD. Trial registration: Clinicaltrials.gov identifier NCT02885792.

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“… 47 Furthermore, despite the commencement of highly protocolized heart attack pathways, the disparity in terms of revascularization rate between patients with and without SMI did not significantly improve between 1991 and 2014 in Scotland, 10 or between 1996 and 2015 in Denmark. 48 …”

Section: Pathways To Cvd Health Care: Revasculariz...mentioning

confidence: 99%

Interaction Between Race, Ethnicity, Severe Mental Illness, and Cardiovascular Disease

O’Gallagher

Teo

Shah

et al. 2022

JAHA

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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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Time Trends in the Use of Coronary Procedures, Guideline-Based Therapy, and All-Cause Mortality following the Acute Coronary Syndrome in Patients with Schizophrenia

Cited by 8 publications

References 20 publications

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Peripheral artery disease in patients with schizophrenia as compared to controls

Interaction Between Race, Ethnicity, Severe Mental Illness, and Cardiovascular Disease

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