Patients with schizophrenia may not always get the cardiac treatment they should following a myocardial infarction (MI), according to researchers from Aalborg University Hospital, Denmark.
Studies have already established that patients with schizophrenia have a higher prevalence of cardiovascular disease (CVD) and that there is a strong correlation between MI and schizophrenia, the researchers say. Patients with schizophrenia also undergo fewer cardiac procedures compared with the general population. To try to find out why that might be, the researchers focused on the 4-stage process from initial admission following MI: offer of examination, acceptance of examination, offer of treatment, and acceptance of treatment.
Of 141 patients with a first MI, 47 also had a diagnosis of schizophrenia.
The researchers say their data show a “clear difference” between the 2 groups studied. Patients with schizophrenia were statistically significantly less likely to be offered and accept examination and to be offered and accept treatment than were the psychiatrically healthy controls. However, when the researchers analyzed each stage separately, none of the secondary results were statistically significant. Still they say, as a whole the stages contribute to the primary outcome of less cardiac treatment for these patients.
The researchers did find 2 significant differences between the 2 groups: Patients with schizophrenia were more likely to be smokers and have a lower familial predisposition to CVD. They also were less likely to be in treatment for diabetes, hypercholesterolemia and hypertension at the first MI, although that did not reach statistical significance. The 2 groups also differed in the treatments offered. Patients with schizophrenia were less often offered invasive coronary angiography (CAG) and more often offered exercise-ECG. In contrast, the controls were more likely to be offered CAG.
[embed:render:related:node:133340]
Without statistical significance, the researchers could not pinpoint whether physician bias, patients’ unwillingness to receive health care, or both were at the root of the discrepancies. They note that the clinical manifestations of schizophrenia “may be seen as a complication for postoperative care” and influence decisions about cardiac procedures. Those decisions may be based on “tacit assumptions rather than on standard guidelines based on medical outcomes,” the researchers add. Three patients in the study reported that they had previously visited the hospital complaining of typical chest pain but were sent home without examination. The researchers cite another study that found patients with schizophrenia receive care only when their symptoms are “severe enough.”
However, patients with schizophrenia also are known to be more likely to decline treatment, perhaps in part because they do not understand the importance of treatment, the researchers say.
The researchers suggest that the way patients are handled by the treating doctor “needs to be reformed.” It is important, they say, that health care providers are aware of the limits of dealing with a double-diagnosed patient and of the possibility of unintentional bias. A “more personalized approach,” they conclude, might make patients with schizophrenia more willing to cooperate with offers of treatment.