Tanya S Hauck1,2, Ning Liu2,3, Harindra C Wijeysundera2,3,4, Paul Kurdyak1,2,3. 1. Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada. 2. Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. 3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 4. Department of Medicine, Schulich Heart Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. AIMS: To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. METHOD: This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. RESULTS: A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophrenia patients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). CONCLUSIONS: In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.
BACKGROUND:Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. AIMS: To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. METHOD: This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. RESULTS: A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophreniapatients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). CONCLUSIONS: In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.
Entities:
Keywords:
access to care; epidemiology; health disparities; health services research; schizophrenia
Authors: Lars Jakobsen; Christian J Terkelsen; Evald H Christiansen; Michael Maeng; Lisette O Jensen; Karsten Veien; Bent Raungaard; Svend E Jensen; Frank Mehnert; Søren P Johnsen Journal: Am J Cardiol Date: 2017-05-30 Impact factor: 2.778
Authors: Joshua Schulman-Marcus; Parag Goyal; Rajesh V Swaminathan; Dmitriy N Feldman; Shing-Chiu Wong; Harsimran S Singh; Robert M Minutello; Geoffrey Bergman; Luke K Kim Journal: Am J Cardiol Date: 2016-02-17 Impact factor: 2.778
Authors: Dennis T Ko; Harindra C Wijeysundera; Cynthia A Jackevicius; Altayyeb Yousef; Julie Wang; Jack V Tu Journal: Circ Cardiovasc Qual Outcomes Date: 2013-05-14
Authors: Cheryl Enger; Lisa Weatherby; Robert F Reynolds; Dale B Glasser; Alexander M Walker Journal: J Nerv Ment Dis Date: 2004-01 Impact factor: 2.254
Authors: Joe Kwun Nam Chan; Ryan Sai Ting Chu; Chun Hung; Jenny Wai Yiu Law; Corine Sau Man Wong; Wing Chung Chang Journal: Schizophr Bull Date: 2022-09-01 Impact factor: 7.348
Authors: Kelly Fleetwood; Sarah H Wild; Daniel J Smith; Stewart W Mercer; Kirsty Licence; Cathie L M Sudlow; Caroline A Jackson Journal: BMC Med Date: 2021-03-22 Impact factor: 8.775