Patients with other conditions undertreated for CVD after MI
MedWire News: Cardiovascular disease (CVD) is undertreated following myocardial infarction (MI) in patients suffering from other illnesses, two separate studies reveal.
Two unrelated recent studies conducted by European researchers have shown that patients with mental illness and patients with rheumatoid arthritis (RA) who suffer MI are undertreated to prevent further CVD events.
Alex Mitchell (University of Leicester, UK) led a meta-analysis of 22 studies involving 825,754 individuals with defined mental illness and schizophrenia, and compared provision of invasive coronary procedures and subsequent mortality outcomes, with those of individuals without mental ill health.
Findings, published in the British Journal of Psychiatry, showed that patients with any mental illness received a 14% lower rate of cardiac procedures following MI than individuals without mental illness.
Considering each procedure individually, the researchers found there was a 15% lower receipt of CABG, 15% lower receipt of cardiac catherization, and 13% lower receipt of percutaneous transluminal coronary angioplasty/percutaenous coronary intervention (PTCA/PCI) in mentally ill patients, relative to individuals with no mental illness.
Schizophrenic patients were half as likely to undergo a coronary procedure, with a 31% lower rate of CABG and 50% lower rate of PCTA/PCI, than patients with no mental illness.
In six related studies examining mortality following MI, there was an 11% higher mortality rate in the year after MI for those with mental illness (p=0.05) relative to those without, but there was insufficient evidence to examine mortality rates in schizophrenia alone.
In a press statement, Mitchell stated that the higher heart rate of heart disease in mentally ill patients has already been established, and noted that it has been attributed to higher background rates of cardiovascular risk factors, including smoking, inactivity, and obesity.
"We don't yet know the reason for these poorer outcomes, but it is worrying that we also find such patients may receive less frequent life saving interventions," he said.
Speaking to MedWire News, Joep Perk (Linnaeus University, Kalmar, Sweden) explained that mentally ill patients may be undertreated because it is more difficult to obtain their consent for life saving interventions.
In an unrelated study presented at the Annual Congress of the European League Against Rheumatism (EULAR), Jesper Lindhardsen (Gentofte University Hospital, Copenhagen, Denmark) showed that RA patients were significantly less likely to be prescribed post-MI treatments following first-time MI, than healthy controls.
The study involved 98,454 patients (39.4% female), and revealed that at 30 days following first-time MI, RA patients were approximately 20% less likely to be prescribed treatments such as statins and beta blockers than healthy patients. This was still the case at 180 days.
In a press statement, Lindhardsen explained that the study involved obtaining pharmacy records and prescriptions using the Danish National registers to determine whether standard MI treatments had been prescribed or not, and the influence of RA.
"A weakness of this study is its retrospective nature," Perk told MedWire News.
Lindhardsen also pointed out that clinicians may be finding post-MI treatment in RA patients complicated, explaining the lower propensity towards prescribing treatment.
Perk agreed. "RA patients are usually on some form of drug treatment already. Doctors may be hesitant to put their patients on more drugs following MI due to fear of interaction between medications."
"Beta blockers in particular could be a problem," he said.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Piriya Mahendra