Worse care for psychotic heart disease and stroke patients
MedWire News: Heart disease and stroke patients with psychosis do not receive the same standards of care as non-psychotic patients, even under a system of universal healthcare, say Canadian investigators.
Cardiovascular disease is the major cause of excess deaths among patients with psychiatric disorders and studies have indicated that they experience inequalities in medical care. However, the majority of research has been carried out either in specific populations or in areas without universal care.
To determine the standard of comparative care in a jurisdiction with universal healthcare, Stephen Kisely, from Dalhousie University in Halifax, Nova Scotia, and colleagues examined the treatment of 65,039 patients with or without a history of schizophrenia or related psychosis admitted to hospital for ischemic heart disease or stroke between 1995 and 2001.
The results, published in the British Journal of Psychiatry, show that, of 49,248 admissions for ischemic heart disease, 1285 patients had a history of psychosis.
Despite psychosis patients having a significantly higher risk for 1-year mortality than other patients, at an odds ratio of 1.27, they were significantly less likely to receive cardiac catheterization, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, beta blockers and statins, at odds ratios of 0.47, 0.41, 0.35, 0.82, and 0.51, respectively.
Of 15,791 stroke patients, 594 had a history of psychosis. Again, psychosis patients had significantly higher 1-year mortality than non-psychotic patients, at an odds ratio of 1.49, and were significantly less likely to receive cerebrovascular arteriography and warfarin, at odds ratios of 0.47 and 0.55, respectively.
Further research could help establish the relative contribution of system-, physician-, and patient-based factors and how these can be addressed, the team writes.
They conclude: “For some individuals, this could be because of difficulties in communication, registering with a family physician, or scheduling appointments because of frequent changes of address.
“Service providers should also be prepared to accommodate the needs of people with mental illness, as they do those with physical difficulties, to enhance access to medical care.”
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By Liam Davenport