Cardioprotective Treatments After Heart Attack Increase Lifespan of Patients With Schizophrenia

The increased risk of mortality in patients with schizophrenia can be reduced with cardioprotective medication, such as antiplatelets, β-blockers, and statins, after a heart attack, suggests a study published in JAMA Psychiatry.

Previous studies have found that patients with schizophrenia die 10 to 15 years younger and have worse outcomes from coronary artery disease than those in the general population.

“Our study suggests that patients with schizophrenia who are treated with cardioprotective treatment after MI [myocardial infarction] have a lower mortality risk compared with patients who are not treated, similar to those treated in the general population,” wrote Pirathiv Kugathasan, M.D., of Aalborg University in Denmark and colleagues. “Cardioprotective medication after myocardial infarction should be carefully managed to improve prognosis.”

The researchers studied all adults aged 30 and older who were treated in Denmark public hospitals with first-time myocardial infarction (MI) during a 20-year period, involving 105,018 individuals, including 684 patients with a prior diagnosis of schizophrenia. The researchers followed patients up to 20 years and collected data on prescriptions received and defined five cardioprotective therapeutic drug groups: antiplatelets, vitamin K antagonists, β-blockers, angiotensin-converting enzyme inhibitors, and statins. The researchers noted use of monotherapy (treatment with one these medication groups), dual therapy (use of two), and triple therapy (use of three or more) as well as the time to all-cause mortality during the follow-up.

Compared with patients in the general population, patients with schizophrenia were less likely to receive prescriptions for cardioprotective medications after MI. Such patients were nearly nine times more likely to die compared with the general population treated; moreover, even those who received treatment were still nearly twice as likely to die as those treated in the general population.

The triple therapy provided the greatest benefit for patients, however, and patients with schizophrenia who received any combination of triple therapy had mortality rates similar to those observed of the general population who received the same treatment.

“Cardiovascular medications are a mainstay for ensuring health and preventing recurrent cardiovascular events after myocardial infarction,” Benjamin G. Druss, M.D., M.P.H., of Emory University wrote in an accompanying editorial. “The findings of the study by Kugathasan et al suggest that these medications can also play a critical role in reducing mortality among individuals with schizophrenia.”

For related information, see the Psychiatric News article “Patients With Serious Mental Illness Need Better Primary Care Integration, Health Advocacy.”

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Electronic Personal Health Record Improves Care for Those With Serious Mental Illness, Study Finds

Having a personal health record results in significantly improved quality of medical care and increased use of medical services among patients with serious mental illness, according to the study, “Randomized Trial of an Electronic Personal Health Record for Patients With Serious Mental Illnesses,” published online today in AJP in Advance.

Psychiatrist Benjamin Druss, M.D., and colleagues at Emory University randomly assigned 170 individuals with a serious mental disorder and a comorbid medical condition treated in a community mental health center to either a personal health record or usual care. One-year outcomes assessed quality of medical care, service use, and health-related quality of life. Patients in the intervention group used an electronic personal health record called “My Health Record” to facilitate self-management of their illnesses and interactions with the health system. Core features of the record are personal details; diagnoses; goals and action steps; health indicators, including fields for blood pressure, cholesterol, and glucose levels; medications and allergies; hospital visits; immunizations; and health and family health history. Prompts remind patients about routine preventive services.

Patients used the personal health record a mean of 42.1 times during the intervention period. In the personal health record group, the total proportion of eligible preventive services received increased from 24% at baseline to 40% at the 12-month follow-up, whereas it declined in the usual-care group from 25% to 18%. In the subset of patients with cardiometabolic conditions (N=118), the total proportion of eligible services received improved by 2% in the personal health record group and declined by 11% in the usual-care group.

“This study demonstrated that personal health records hold potential to improve the quality of care among individuals with serious mental illnesses treated in public mental health settings,” Druss and colleagues said.

For more information about innovative work Druss is doing to improve quality of care for the serious mentally ill see the Psychiatric News article, "Psychiatrist Focuses on Populations in Health Delivery Services."

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Geography May Determine Accessibility of Mental Health Care Under Medicaid Expansion

States that opt to expand their Medicaid coverage under the new health care reform law—the Affordable Care Act—will see an increase in the number of enrollees needing mental health care. This is significant because Medicaid already funds more mental health services than any other payer in the United States. But concerns have been raised over whether there are enough mental health clinicians and facilities that accept Medicaid available to serve those new enrollees and whether this newly eligible population will face access obstacles. There is a particular severe shortage of such clinicians and facilities in many rural areas and in communities with large percentages of black or Hispanic residents, said Emory University’s Janet Cummings, Ph.D., Benjamin Druss, M.D., M.P.H., and colleagues, in JAMA Psychiatry online August 21. The effect size was largest for rural communities.

The researchers compared data from the 2008 National Survey of Mental Health Treatment Facilities with sociodemographic information from more than 3,100 U.S. counties.

“More than one-third of counties do not have any outpatient mental health facilities that accept Medicaid,” they pointed out. “If communities with a high concentration of black and/or Hispanic residents experience higher than average Medicaid enrollment but are more likely to lack these facilities, policies will need to be implemented to ensure that the Medicaid expansion does not exacerbate disparities in the accessibility of services for these communities.”

For more in Psychiatric News about the ACA’s effect on Medicaid patients, see “States’ Decisionon Expanding Medicaid Will Impact Inpatient Psychiatric Care.” Additional information on Medicaid funding for mental health care can be found in Psychiatric Services.

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