Assessing the quality of acute cardiological care for patients with severe mental illness

Kisely, Steve and Campbell, Leslie-Anne (2009). Assessing the quality of acute cardiological care for patients with severe mental illness. In: Australian and New Zealand Journal of Psychiatry: Abstracts from the Royal Australian and New Zealand College of Psychiatrists 44th Congress. The Royal Australian and New Zealand College of Psychiatrists 44th Congress, Adelaide, Australia, (A31-A31). 24 - 28 May, 2009.


Author Kisely, Steve
Campbell, Leslie-Anne
Title of paper Assessing the quality of acute cardiological care for patients with severe mental illness
Conference name The Royal Australian and New Zealand College of Psychiatrists 44th Congress
Conference location Adelaide, Australia
Conference dates 24 - 28 May, 2009
Proceedings title Australian and New Zealand Journal of Psychiatry: Abstracts from the Royal Australian and New Zealand College of Psychiatrists 44th Congress   Check publisher's open access policy
Place of Publication Sydney, Australia
Publisher Informa Healthcare
Publication Year 2009
ISSN 1440-1614
0004-8674
Volume 43
Issue Supp. 1
Start page A31
End page A31
Total pages 1
Language eng
Formatted Abstract/Summary Background:  Circulatory disease, not suicide, is the major cause of excess death in psychiatric patients. Australian and Canadian data suggest that people with mental illness, especially psychosis, do not receive equitable levels of specialised procedures such as percutaneous transluminal coronary angioplasty and coronary artery bypass grafts.

Objectives: We investigated whether patients admitted for myocardial infarction with a history of psychosis (ICD9 295, 297-8) received equitable levels of the following guide line-consistent treatments compared to non-psychiatric controls:  beta-blockers, ACE inhibitors, statins, clopidogrel and angiotensin receptor blockers (ARBs).

Method: A population-based case-control study of 49,248 Canadians admitted with myocardial infarction (MI). Of these, 11,139 had previous contact with primary or secondary care for psychiatric problems from 1995 to 2001. 1285 patients had a history of psychosis. We adjusted for confounders including age, gender, income and medical comorbidity.

Findings:
Patients with a history of psychosis had a higher 1-year mortality compared to controls (ORadj=1.3 95%CI=1.1-1.5).  However, on either univariate or multivariate analyses (significance pB0.05), these patients had only a 25 to 80% chance of  receiving any of the guideline-consistent treatments during, or on discharge, from their admission for MI compared to controls: e.g. cardiac catheterisation (ORadj=0.12 95%CI=0.1-0.2), beta-blockers (ORadj= 0.79, 95%CI=0.7-0.9), statins (ORadj=0.24, 95%CI=0.1-0.4),ARBs (ORadj=0.22, 95%CI=0.1-0.9), and clopidogrel (ORadj= 0.68, 95%CI=0.5-0.99).

Conclusions: People with a history of psychosis do not receive equitable levels of  evidence-based treatment for acute MI, even under greater universal health care than Australia. Possible explanations include reduced patient adherence to treatment, difficulties in communication or access, and stigma.

Subjects 111714 Mental Health
1103 Clinical Sciences
110319 Psychiatry (incl. Psychotherapy)
110201 Cardiology (incl. Cardiovascular Diseases)
Keyword Acute cardiological care
Patient care
Severe mental illness
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Unknown

 
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Created: Wed, 09 Dec 2009, 14:54:52 EST by Elissa Saffery on behalf of School of Health & Rehabilitation Sciences