High Mortality and Low Access to Care Following Incident Acute Myocardial Infarction in Individuals with Schizophrenia

Objectives: The primary objective of this study was to compare mortality following incident acute myocardial infarction (AMI) among individuals with and without schizophrenia. A secondary objective was to compare the likelihood to receive cardiac procedures and cardiologist visits.

Methods: This retrospective cohort study took place in Ontario, Canada. We studied incident AMI patients who were alive at hospitalization discharge from January 1, 2002 to December 31, 2006. 71,668 subjects were included in the study (402 subjects were excluded because of missing data). The main exposure was a diagnosis of schizophrenia. The main outcome measure was 30-day mortality post-discharge. Secondary outcomes included receipt of cardiac procedures and cardiologist visits within 30 days post-discharge.

Results: After risk adjustment, individuals with schizophrenia were 56% more likely to die within 30 days of discharge (OR 1.56, 95% CI 1.08-2.23; p=0.02), but approximately 50% less likely to receive cardiac procedures (OR 0.48, 95% CI 0.40-0.56; p<0.001) or to see a cardiologist within 30 days of discharge (OR 0.53, 95% CI 0.43-0.65; p<0.001).

Conclusions: Individuals with schizophrenia have a significant risk of dying following incident AMI. Despite the elevated mortality risk, individuals with schizophrenia are less likely to receive specialist care and cardiac procedures. Inequities in access to AMI care may be an important point of intervention for individuals with schizophrenia.