A new meta-analysis published in the British Journal of Psychiatry has found that people with mental health problems are significantly less likely to receive important cardiac treatment (revascularisation, angiography, angioplasty and bypass grafting) following a cardiac event.
- People with mental illness experience a 14% lower rate of invasive coronary interventions following a cardiac event and have an 11% increased mortality rate.
- The rate of invasive coronary interventions for people with schizophrenia is even lower at 47% of the norm.
A systematic search and random effects meta-analysis was conducted by Dr Alex Mitchell from the Department of Liaison Psychiatry at Leicester Royal Infirmary, who identified 22 analyses of possible inequalities in coronary procedures in those with defined mental disorder, of which 10 also reported results in schizophrenia or related psychosis.
People with schizophrenia and mental illness in general had lower rates of life saving treatments than people without mental illness.
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The authors conclude that further work is needed before any kind of causal link can be established.
Mitchell and Lawrence. Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis. The British Journal of Psychiatry.2011; 198: 434-441. [Abstract].
Mental health patients are unlikely to be diagnosed with heart problems as A&E Departments ignore cardiac (and other) symptoms in patients with a mental health label.
The RCPsych has told psychiatrists to order routine ECGs in a bid to reduce the incidence of sudden cardiac death. Unfortunately psychiatrists do not have the expertise to interpret the graphs and, even with the aid of computerised reports, fail to refer the patient to a Cardiologist or report the abnormal findings to the GP in the discharge summary.
I did not know I had a heart problem until I obtained my psych records in connection with a different matter. When I showed my GP the ECGs, he referred me to a Cardiologist for urgent tests. I had not only had two heart attacks whilst an inpatient on a mental health ward but had not received my blood pressure medication for 2 weeks despite the fact that my summary care record was provided on the day of admission.
The situation will not change until mental health patients receive appropriate treatment for physical conditions. Doctors need to learn to see beyond the mental health label.
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