Treatment following myocardial infarction in patients with schizophrenia

Abstract

BackgroundA correlation between excess mortality from myocardial infarctions (MI) and schizophrenia has already been established. What remains unclear is whether the initial communication between the treating doctor and the corresponding patient contributes to this excess mortality.AimThe aim of this study is to investigate whether a patient with schizophrenia receives the same offers for examination and treatment following a MI compared to a psychiatric healthy control (PHC).MethodsThis cohort study includes patients diagnosed with schizophrenia at the time of their first MI (n = 47) in the years between 1995–2015 matched 1:2 to psychiatric healthy MI patients on gender, age and year of first MI. All existing hospital files for the 141 patients were thoroughly reviewed and the number of offered and accepted examinations and treatments were extracted for comparisons between the two groups.ResultsIn general patients with schizophrenia were less likely to be offered and accept examination and at the same time be offered and accept treatment as compared to PHCs (p<0.01). In addition, there was a statistical trend towards patients with schizophrenia being more likely to decline examination (p = 0.10) and decline treatment (p = 0.09) compared to PHCs, while being offered examination and being offered treatment both contributed statistically insignificantly to the overall discrepancy between the two patient groups.ConclusionsBeing diagnosed with schizophrenia limits the treatment received following a first MI compared to PHCs. However, we are unable to pinpoint, whether Physician bias, patient’s unwillingness to receive health care or both contribute to the excess mortality seen in these comorbid patients.

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

“…Despite the progression and availability of coronary procedures and the increasing awareness of the discrepancies in these populations, the significant difference in the use of CAG, PCI, and CABG between the populations has remained constant for the last 20 years. This is in accordance with previous research that has found fewer coronary procedures in the population with schizophrenia as compared to the general population, which has been ascribed to a combination of patient denial of symptoms, patient decline of treatment offers, and fewer offers made by the doctor [6].…”

“…Schizophrenia is associated with higher mortality rates than those in the general population mainly driven by natural causes of death, including acute coronary syn-drome (ACS) [1][2][3][4]. Hypotheses regarding the causal factors resulting in the increased mortality are many, nonetheless data support an increased prevalence of cardiac risk factors, metabolic side effects following the use of antipsychotic medication, as well as a decreased awareness or ability to describe symptoms in patients and a potential bias towards the patient from professionals [5][6][7].…”

Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia

“…have concluded that patients with schizophrenia receive suboptimal preventive and cardiac care despite being at such high risk. [7][8][9][10] Furthermore, the use of atypical antipsychotic medications also contributes to the development of metabolic syndrome and consequently increases the risk of cardiovascular disease. 11 Despite the increased interest in this topic, there is a lack of comprehensive studies of the schizophrenia population with regards to comorbidities, in-hospital treatment, discharge medications and outcomes following AMI in contemporary nationwide study samples.…”

“… 5 6 Notably, several studies have concluded that patients with schizophrenia receive suboptimal preventive and cardiac care despite being at such high risk. 7–10 Furthermore, the use of atypical antipsychotic medications also contributes to the development of metabolic syndrome and consequently increases the risk of cardiovascular disease. 11 …”

Women who suffer from schizophrenia: Critical issues

“…Social precipitants of early death are critical in this population: Poverty[ 154 ], homelessness[ 155 ], social isolation[ 156 ], poor hygiene[ 157 ], malnourishment[ 158 ], exposure to toxic substances[ 159 ] and adverse treatment effects[ 114 ]. High mortality from diabetes, cardiovascular disease and malignancies can, in part, be due to a relative lack of screening, delays in diagnosis, and suboptimal treatment[ 94 , 95 , 160 - 162 ]. Javatilleke et al[ 163 ] conclude their list of causes of lost life expectancy in severe mental illness by pointing out that the range of causes is very broad, with many putative causes varying according to gender.…”