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Coronary artery disease
Original research
Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia
  1. Rubina Attar1,2,
  2. Axel Wester1,
  3. Sasha Koul3,
  4. Svend Eggert2,
  5. Christoffer Polcwiartek2,
  6. Tomas Jernberg4,
  7. David Erlinge1 and
  8. Pontus Andell1,5
  1. 1Cardiology and Clinical Sciences, Lund University, Lund, Sweden
  2. 2Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
  3. 3Cardiology, Lund University, Lund, Sweden
  4. 4Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
  5. 5Unit of Cardiology, Department of medicine and Heart and Vascular Division, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Dr Rubina Attar; r.attar{at}rn.dk

Abstract

Background Patients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy.

Purpose To 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).

Methods All 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.

Results Patients 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.

Conclusion Patients 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.

  • coronary artery disease
  • epidemiology
  • acute coronary syndrome
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001286

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    Footnotes

    • Presented at Parts of the results have previously been presented in poster format at the European Society of Cardiology Congress.

    • Contributors RA designed the study, developed the protocol and analysis plan as well as performed the statistical analyses. RA, AW, SE, TJ, DE, CP and PA interpreted the results and provided feedback. RA wrote the first draft of the manuscript which was shaped by the critical revision of all coauthors. All authors approved the final version suitable for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Swedish Ethical Review Authority at Lund University. There was no patients nor public involvement in this study. No patients consent was required for publication due to anonymisation.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All patients were deidentified upon inclusion.