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STEMI treatment disparities persist for patients with severe mental illness
Patients with severe mental illness are less likely to receive revascularization therapies for treatment of STEMI, according to a recent study published in the American Journal of Cardiology.
“In contrast to the overall population, the incidence of STEMI is not decreasing in patients with severe mental illness,” Joshua Schulman-Marcus, MD, from the departments of medicine at radiology at Weill Cornell Medical College, New York, and colleagues wrote.
The researchers analyzed data from the 2003-2012 National Inpatient Sample to examine trends in STEMI incidence, revascularization and in-hospital mortality in patients with and without severe mental illness.
Of the 3,058,697 patients with STEMI included in the analysis, about 1% had severe mental illness. Almost 43% of the patients with severe mental illness had schizophrenia and 53% had bipolar disorder. Approximately 4% of the patients had both schizophrenia and bipolar disorder.
Patients with severe mental illness were typically younger, with a history of substance abuse, diabetes, depression, neurological disorders, congestive HF, chronic pulmonary disease and obesity, and more likely to be female and nonwhite. In addition, patients with severe mental illness had longer hospital stays and often were not discharged to home. Those patients without severe mental illness typically had higher rates of previous revascularization with PCI or CABG, rheumatologic disease, renal failure, valvular heart disease and peripheral vascular disease.
The researchers also found significant differences between patients with schizophrenia and patients with bipolar disorder. While congestive HF, chronic pulmonary disease, neurologic disorders and renal failure were more common in patients with schizophrenia, patients with bipolar disorder were more likely to have hypertension, obesity, previous revascularization procedures and substance abuse.
From 2003 to 2012, the incidence of STEMI decreased by 50% among patients without severe mental illness, from 9,455 to 4,652 per million adults per year (P < .001). The researchers did not observe a significant decrease in the incidence of STEMI among patients with severe mental illness (from 71 to 64 per million adults per year; P = .1). Within the two mental illness subgroups, the incidence of STEMI decreased by 39% in patients with schizophrenia (P < .001), but increased by 33% in patients with bipolar disorder (P = .002).
After adjustment for potential confounders, the odds of revascularization were reduced by 41% among patients with severe mental illness (31% reduction for PCI, 41% reduction for CABG; P < .001 for all) and the odds of mortality were reduced by 13% (P < .001). Schizophrenia was associated with increased mortality in both unadjusted and adjusted models.
According to the researchers, these findings “also draw attention to the broader context of cardiovascular disease in patients with severe mental illness.” They noted that “both schizophrenia and bipolar disorder are associated with the premature onset of cardiovascular disease.”
The results of this study “highlight persistent disparities and the ongoing need to improve STEMI care in patients with severe mental illness,” the researchers concluded. – by Tracey Romero
Disclosures: Schulman-Marcus reports no relevant financial disclosures. Please see the full study for a list of all researchers’ relevant financial disclosures.