Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare

Kisely, Steve; Campbell, Leslie Anne; Wang, Yan

doi:10.1192/bjp.bp.109.067082

Cited by 103 publications

(115 citation statements)

References 35 publications

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“…18,[91][92][93] They are also less likely to receive appropriate medications on discharge such as beta blockers and statins. 94 The results are consistent with findings from ambulatory and primary care where patients with severe mental illness were less likely to be assessed or treated for hyperlipidaemia. 95,96 The few exceptions to these findings are in highly specific groups such as patients of Veterans Affairs.…”

Section: Effect Of Mental Illness On Physical Health Caresupporting

confidence: 85%

The Epidemiology of Excess Mortality in People with Mental Illness

2010

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T he excess mortality of people with mental illness has been known for many years. In 1841, William Farr 1 reported to the Royal Statistical Society on mortality within the major asylums and licensed houses of the period in England. He estimated, using life-table methods, the mortality rate in the best facility to be about 3 times that of the general population, and mortality in other facilities to be several times higher again. The report inspired the British parliament to require regular compilation of statistics within all asylums, and established mortality rate as a measure of the quality of care provided. The high mortality was attributed to infectious diseases and the poor conditions within the asylums, such as lack of exercise and warmth, poor diet, and lack of medical care. During subsequent years, mortality in people with mental illness has been the subject of hundreds of studies. In the most comprehensive meta-analyses to date, Harris and Barraclough 2,3 identified 152 reports on all-cause mortality and 249 on suicide. They found that all mental disorders were associated with an increased risk of premature death. Overall

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Section: Effect Of Mental Illness On Physical Health Caresupporting

confidence: 85%

The Epidemiology of Excess Mortality in People with Mental Illness

2010

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“…Further research could establish whether patients given community treatment orders are more likely to receive appropriate care, because patients with psychiatric disorders are less likely to re ceive guideline-consistent management of physical illness. 4,6,24,25 …”

Section: Resultsmentioning

confidence: 99%

Reducing all-cause mortality among patients with psychiatric disorders: a population-based study

Kisely

Preston

Xiao

et al. 2012

CMAJ

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“…Using data from APPROACH, extent of coronary disease was assessed using 3 different measures: 1) left ventricular ejection fraction (LVEF); 2) the Duke Jeopardy Score, which encompasses both the percentage of stenosis in a coronary lesion and the volume of myocardium at risk (the Duke Jeopardy Score has been validated in the APPROACH population and has been shown to provide independent prognostic information in people with ischemic heart disease) [9,10]; and 3) a categorical assessment of coronary anatomy risk, with high risk anatomy defined as 3-vessel disease, left main disease, or 2-vessel disease involving the proximal left anterior descending coronary artery per the Duke Coronary Index.…”

Section: Clinical and Outcome Variablesmentioning

confidence: 99%

“…Previous research has shown that people with schizophrenia are less likely to undergo cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) relative to those without schizophrenia [9][10][11][12]. Factors such as cardiac surgeon selection bias [13], socio-economic barriers [14], and informed consent issues [6] have been postulated as possible causes for this discrepancy.…”

Section: Introductionmentioning

confidence: 98%

Coronary artery disease in adults with schizophrenia: Anatomy, treatment and outcomes

Todd

Lewin

Bresee

et al. 2014

IJC Heart & Vessels

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Background: People with schizophrenia are at significantly greater risk of cardiovascular disease-related mortality. We set out to determine if people with and without schizophrenia who undergo coronary artery catheterization differ with respect to coronary anatomy, coronary artery disease management, or outcome. Methods and results: This study used provincial administrative data and a clinical registry that included all individuals who undergo coronary catheterization in Alberta, Canada. Individuals with schizophrenia were identified in hospital discharge data using ICD-9 codes. We identified 271 Albertans with a hospital discharge diagnosis of schizophrenia and a subsequent coronary catheterization and were matched with 1083 controls without schizophrenia that had undergone a coronary catheterization. Extent of coronary disease was assessed using 1) left ventricular ejection fraction; 2) the Duke Jeopardy Score (a valid measure of myocardium at risk for ischemic injury); and 3) a categorical assessment of coronary anatomy risk. People with schizophrenia were less likely to be categorized as high risk on the Duke coronary index (p b .005) and more likely to be categorized as having a normal coronary anatomy (p b .05). Significant differences in mortality were found among those with and without schizophrenia both before and after adjustment for clinical differences. Conclusions: Our results suggest that people with schizophrenia have less severe coronary atherosclerosis, and are less likely to receive revascularization. Despite less severe coronary atherosclerosis, individuals with schizophrenia had a significantly higher mortality following catheterization. Interventions to increase therapeutic adherence and clinical follow up of patients with mental illness may improve health outcomes.

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Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare

Abstract: People with a history of psychosis do not receive equitable levels of vascular care under universal healthcare.

Cited by 103 publications

References 35 publications

The Epidemiology of Excess Mortality in People with Mental Illness

The Epidemiology of Excess Mortality in People with Mental Illness

Reducing all-cause mortality among patients with psychiatric disorders: a population-based study

Coronary artery disease in adults with schizophrenia: Anatomy, treatment and outcomes

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