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

Abstract

BackgroundPatients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy.PurposeTo investigate patients with and without schizophrenia experiencing an acute myocardial infarction (AMI) in relation to guideline recommended in-hospital management, discharge medications and 5-year major adverse cardiac events (MACE: composite of all-cause mortality, rehospitalisation for reinfarction, stroke or heart failure).MethodsAll patients with schizophrenia who experienced AMI during 2000–2018 were identified (n=1008) from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and compared with AMI patients without schizophrenia (n=2 85 325). Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations.ResultsPatients with schizophrenia presented with AMI approximately 10 years earlier (median age 64 vs 73 years), and had higher prevalences of diabetes, heart failure and chronic obstructive pulmonary disease. They were less likely to be invasively investigated or discharged with aspirin, P2Y12 inhibitors, ACE inhibitors/angiotensin II receptor blockers, beta-blockers and statins (all p<0.005). AMI patients with schizophrenia had higher adjusted risk of MACE (aHR=2.05, 95% CI 1.63 to 2.58), mortality (aHR=2.38, 95% CI 1.84 to 3.09) and hospitalisation for heart failure (aHR=1.39, 95% CI 1.04 to 1.86) compared with AMI patients without schizophrenia.ConclusionPatients with schizophrenia experienced an AMI almost 10 years earlier than patients without schizophrenia. They less often underwent invasive procedures and were less likely to be treated with guideline recommended medications at discharge, and had more than doubled risk of MACE and all-cause mortality. Improved primary and secondary preventive measures, including adherence to guideline recommendations, are warranted and may improve outcome.

The Outcomes of Acute Coronary Syndrome in Patients Suffering From Schizophrenia: A Systematic Review

“…In our systematic review, we studied the main outcome of ACS in patients with schizophrenia. [16,23,26].…”

“…In addition, during the post-myocardial infarction (MI) care, there are further dissimilarities in providing care, with lower rates of cardiology specialist visits in the 30-days post-ACS in patients with schizophrenia when compared to those without (12.2% vs 20.1%, respectively) [30]. Other secondary prevention measures were also lower in schizophrenia patients, including the prescription of statins, beta-blockers, and anti-platelets [16].…”

“…This suboptimal healthcare may be due to subconscious bias and stereotyping by health care providers when taking care of patients with severe mental illnesses overall and with schizophrenia specifically by deprioritizing those patients during ACS events [16]. There seems to be a preset perception that this population is poorly compliant, difficult to obtain medical or surgical treatment consents, and overall challenging to treat [27].…”

“…Patients who have a diagnosis of schizophrenia are considered to be more vulnerable to cardiovascular diseases (CVD) than mentally healthy patients due to the high prevalence of CVD risk factors, such as obesity, metabolic disorder, diabetes, and smoking, in those patients [10][11]. Moreover, it has been shown that there is inequality in the management of ACS between patients with schizophrenia and mentally healthy patients with lower rates of revascularization and cardioprotective therapy prescriptions [12][13][14][15][16]. As a consequence, a number of recent studies have explored whether ACS outcomes are worse in patients with schizophrenia using various study designs [17].…”

Application of Extreme Learning Machine in the Survival Analysis of Chronic Heart Failure Patients With High Percentage of Censored Survival Time

“…In recent years, with the rapid development of artificial intelligence, machine learning technology has been used to build cardiovascular disease prediction models more and more widely (13)(14)(15). In models for aging patients, many studies have also proved that the prediction performance of the survival model based on machine learning is better than the traditional Cox proportional hazard model (16). Survival analysis models the time to event (17).…”