Diagnostic tests and treatment procedures performed prior to cardiovascular death in individuals with severe mental illness

• Published in: Acta psychiatrica Scandinavica 2020-05, Vol.141 (5), p.439-451
• Main Authors: Heiberg, I. H., Nesvåg, R., Balteskard, L., Bramness, J. G., Hultman, C. M., Næss, Ø., Reichborn‐Kjennerud, T., Ystrom, E., Jacobsen, B. K., Høye, A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Arrhythmia; Bipolar disorder; Bipolar Disorder - epidemiology; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - mortality; Cardiovascular Diseases - therapy; Cause of Death; death; delivery of health care/standards; Diagnostic tests; Diagnostic Tests, Routine - statistics & numerical data; Echocardiography; EKG; Epidemiologi medisinsk og odontologisk statistikk: 803; Epidemiology medical and dental statistics: 803; Female; Health sciences: 800; Helsefag: 800; Humans; Male; Medical disciplines: 700; Medisinske Fag: 700; Mental disorders; Mental Disorders - epidemiology; Middle Aged; Norway - epidemiology; Original; Patients; Prevalence; Primary Health Care - statistics & numerical data; Risk Factors; Schizophrenia; Schizophrenia - epidemiology; Surgery; Ultrasound; VDP; Young Adult
• ISSN: 0001-690X; 1600-0447; 1600-0447
• DOI: 10.1111/acps.13157

Objective To examine whether severe mental illnesses (i.e., schizophrenia or bipolar disorder) affected diagnostic testing and treatment for cardiovascular diseases in primary and specialized health care. Methods We performed a nationwide study of 72 385 individuals who died from cardiovascular disease, of whom 1487 had been diagnosed with severe mental illnesses. Log‐binomial regression analysis was applied to study the impact of severe mental illnesses on the uptake of diagnostic tests (e.g., 24‐h blood pressure, glucose/HbA1c measurements, electrocardiography, echocardiography, coronary angiography, and ultrasound of peripheral vessels) and invasive cardiovascular treatments (i.e., revascularization, arrhythmia treatment, and vascular surgery). Results Patients with and without severe mental illnesses had similar prevalences of cardiovascular diagnostic tests performed in primary care, but patients with schizophrenia had lower prevalences of specialized cardiovascular examinations (prevalence ratio (PR) 0.78; 95% CI 0.73–0.85). Subjects with severe mental illnesses had lower prevalences of invasive cardiovascular treatments (schizophrenia, PR 0.58; 95% CI 0.49–0.70, bipolar disorder, PR 0.78; 95% CI 0.66–0.92). The prevalence of invasive cardiovascular treatments was similar in patients with and without severe mental illnesses when cardiovascular disease was diagnosed before death. Conclusion Better access to specialized cardiovascular examinations is important to ensure equal cardiovascular treatments among individuals with severe mental illnesses.