Wednesday, July 6, 2022

Patients With SMI More Likely to Die After Acute Cardiac Event

Individuals with serious mental illness (SMI)—including schizophrenia, bipolar disorder, and other nonaffective psychoses—were more likely to die following acute cardiac syndrome than those without the disorders, according to a meta-analysis in Schizophrenia Bulletin. Acute cardiac syndrome is characterized by a sudden reduction or blockage of blood flow to the heart.

Those with SMI were also found to be less likely to receive revascularization procedures (such as stent implants) to restore blood flow to the heart and medications that protect the heart (such as ACE inhibitors, beta-blockers, statins, and aspirin) following acute cardiac syndrome.

“Our findings underscore an urgent need to adequately address physical health disparities experienced by this vulnerable population,” wrote lead author Joe Kwun Nam Chan, a Ph.D. student, and Wing Chung Chang, M.D., both of the University of Hong Kong and colleagues.

The researchers analyzed data from 22 studies comparing mortality from acute cardiac syndrome, revascularization, and receipt of cardioprotective medications among 12 million patients, of whom 503,686 had SMI. Studies included in the analysis were from Australia, Canada, Denmark, Hong Kong, Sweden, Taiwan, United Kingdom, and the United States.

Overall, the meta-analysis revealed that SMI patients exhibited an increased risk of death following acute cardiac syndrome, with significantly elevated overall, 30-day, and one-year death rates (40%, 26%, and 68% higher rates, respectively) compared with those without SMI. Patients with SMI were 46% less likely to receive coronary revascularization and 11% less likely to receive cardioprotective medications after acute cardiac syndrome.

The “association between SMI and inferior medical care could be explained by an array of patient, physician, and system factors,” the authors wrote. For example, psychosis symptoms, diminished motivation, and cognitive dysfunction may compromise a patient’s ability to manage other diseases, leading to poorer outcomes. They added that stigmatizing attitudes of health care professionals toward people with SMI and a lack of coordinated care for psychiatric and physical disorders may also lead to delays in care.

“Effective multipronged interventions are urgently needed to reduce these physical health disparities,” the authors wrote. Such strategies include educating patients about the importance of regular exercise, smoking cessation, and maintaining a healthy weight; prescribing antipsychotics judiciously to minimize the risk of metabolic syndrome and cardiotoxicity; and teaching patients how to manage their physical conditions. Further, physicians and health systems can develop treatment algorithms that are specific to people with SMI to help identify those at high risk of cardiac disease, the authors wrote.

For related information, see the Psychiatric News article “Cardioprotective Treatments After Heart Attack Can Help Patients With Schizophrenia Live Longer.”

(Image: iStock/magicmine)

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