Table 2.
Summary of comparative studies reporting on receipt of cardiac medication in patients with schizophrenia (or severe mental illness)
| Author (country) | Treatment | Mental illness types | Sample | Setting | Result | Statistical summary |
|---|---|---|---|---|---|---|
| Desai et al. (2002b) US (VA) | Cardiac care treatment, use of aspirin, use of b-blockers | ICD9 defined schizophrenia or other psychotic disorder | National sample of 5886 veterans discharged from VHA hospitals with a principal diagnosis of acute MI up to 6 months before the index study date. Overall, 27.4% had a diagnosed mental illness. Aged under 65 years. Controlled for age, sex, race, level of VHA service connectedness and distance from veteran’s home to nearest VHA medical facility, chronic medical conditions and use of medical services in the past year (number of primary care visits, number of specialty medical visits, and number of medical inpatient days) and hospital size. | Community patients | In fully adjusted analyses, use of b-blockers was 5% less likely among patients with a substance use disorder compared with those with no such disorder. Aspirin 181/188 vs. 5233/5423 HR 0.938822 95%CI 0.446455 –2.368385 b-blocker 170/188 vs. 5070/5423 0.7 HR b-blocker 0.43–1.2 | Aspirin OR = 1.07 (95% CI 0.49–2.3) b-blocker OR = 0.70 (95% CI 0.43–1.15) cholesterol OR = 1.01 (95%CI 0.369–2.77) |
| Druss et al. (2001) US (Medicare) | Cardiac care treatment Reperfusion therapy, aspirin, beta-blockers and ACE inhibitors. | ICD9 definition: any mental disorder (n = 4664) Schizophrenia (n = 161) Affective disorder (n = 271) Substance use disorder (n = 882) | 88,241 Medicare patients hospitalized for a clinically confirmed MI. Data from Medicare controlled for eligibility for procedure, demographics, cardiac risk factors, left ventricular function, admission and hospital characteristics and regional factors. | Hospitalized patients | As compared with those without a psychiatric disorder, patients with schizophrenia were less likely to have reperfusion, b-blockers and ACE inhibitors. Patients with affective disorders were less likely to have reperfusion and aspirin and those with substance use disorders were less likely to be given ACE inhibitors | ACE OR = 0.814 (95% CI 0.654–0.983) Aspirin OR = 0.807 (95% CI 0.652–0.975) b-Blocker OR = 0.845 (95% CI 0.722–0.984) |
| Hippisley-Cox et al. (2007) UK | Cardiac care treatment RRs of receiving statins, prescription for aspirin, antiplatelets, anticoagulants or b-blockers. | Schizophrenia from EMIS medical records system (primary care record) | 127,932 patients with CHD of whom 701 had a diagnosis of schizophrenia or bipolar disorder. The results were adjusted for age, sex, deprivation, diabetes, stroke and smoking status, and allowed for clustering by practice. | Primary care | Although there were no differences in several parameters, patients with schizophrenia were 15% less likely to have a recent prescription for a statin (95% CI 8% to 20%) and 7% less likely to have a recent record of cholesterol level (95% CI 3% to 11%) than those without mental illness. | b-Blocker OR = 0.96 (95% Cl 0.88–1.06) asprin OR = 1 (95% CI 0.97–1.04) statin OR = 0.85 (95% CI 0.8– 0.91) |
| Petersen et al. (2003) US (VA) | Cardiac care treatment examined age adjusted RR for thrombolytics and use of meds at discharge (b-Blockers, ACE inhibitors, aspirin). | ICD9 defined or problems were patients who had an admission to an inpatient psychiatric or substance abuse unit in the year prior to cardiac admission. | 4340 veterans discharged after a clinically confirmed MI. 859 (19.8%) had mental illness (identified if had been admitted to a psychiatric hospital, received a mental health diagnosis or been seen in a psychiatric or drug/alcohol clinic, all in the year before). Includes unspecified number with schizophrenia. Controlled for age, comorbidity and hospital characteristics. | Secondary care | Those with MI less likely to undergo inpatient diagnostic angiography, age adjusted RR = 0.9 (95% CI 0.83–0.98). No difference in RR of CABG or receipt of meds. | ACE inhibitor OR = 0.919 (95% CI 0.786–1.09) aspirin OR = 0.959 (95% CI 0.812–1.15) b-blocker OR = 0.784 (CI 0.686–0.915) |
| Plomondon et al. (2007) US | Rate of cardiac procedures. | ICD9 defined 18.4% (n = 2,623) of the study population had a diagnosis of SMI. Of the patients with SMI, 65.5% (n = 1718) had a diagnosis of anxiety disorder, 47.1% (n = 1235) had a diagnosis of mood disorder, 15.5% (n = 406) had a diagnosis of schizophrenia, and 11.7% (n = 307) had a diagnosis of personality disorder (not mutually exclusive categories). | 14,194 patients (including 18% with mental illness and 406 with schizophrenia). Setting was VHA. | Hospitalized patients | There were no significant differences in cardiac procedure use, including coronary angiogram (38.7% vs. 40.3%, p = 0.14) or coronary revascularization (31.0% vs. 32.3%, p = 0.19), and discharge medications between those with and without SMI. | ACE inhibitor OR = 0.926 (95% CI 0.841– 012) aspirin OR = 0.93 (95% CI 0.83–1.044) b-blocker OR = 1.11 (95% CI 0.97–1.28) |
| Weiss et al. (2006) US | ACE inhibitor or ARB antihypertensive medication | Schizophrenia by ICD-9 code (295,297, or 298), as having a psychotic disorder. | 214 patients with schizophrenia or a schizophrenia-related syndrome vs. 3594 with diabetes but no severe mental illness. | Mixed settings | Patients with elevated blood glucose (HbA1c greater than 7%) were taking a hypoglycaemic medication (92% of comparison patients and 95% of schizophrenia patients). However, patients with schizophrenia were slightly more likely than comparison patients to specifically receive insulin therapy (47% compared with 38%); aOR = 1.44, p = 0.08). In addition, although the patients with hyperlipidemia in the two groups were equally likely to receive some form of lipid-lowering therapy, those with schizophrenia were significantly more likely to receive one of the older, NS agents (14% compared with 7%; aOR=1.85, p < 0.05). | ACE inhibitor OR = 0.83 aspirin OR = 0.89 (95% CI 0.64–1.24) b-blocker OR = 0.96 (95% CI 0.54–1.71) insulin OR = 1.44 (95% CI 0.96–2.16) cholesterol NS OR = 1.85 (95% CI 1.11–3.09) statin OR = 0.54 (CI 0.36– 0.51) |
VHA, Veterans Health Administration; MI, myocardial infarction; ACE, angiotensin converting enzyme; CHD, coronary heart disease; NS, non-statin; CI, confidence interval; HR, hazard ratio; OR, odds ratio; aOR, adjusted OR; RR, relative risk.