Higher mortality after myocardial infarction in patients with severe mental illness: a nationwide cohort study

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Higher mortality after myocardial infarction in patients with severe mental illness : a nationwide cohort study

Boden, Robert (author): Uppsala universitet,Psykiatri, Akademiska sjukhuset

Molin, E. (author): Uppsala universitet,Psykiatri, Akademiska sjukhuset

Jernberg, T. (author): Karolinska Institutet

Kieler, H. (author): Karolinska Institutet

Lindahl, Bertil (author): Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)

Sundström, Johan (author): Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)

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2014-12-08
2015
English.
In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 277:6, s. 727-736

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Journal article (peer-reviewed)

Abstract Subject headings

ObjectivesThe aim of this study was to explore the impact of severe mental illness (SMI) on myocardial infarction survival and determine the influence of risk factor burden, myocardial infarction severity and different treatments. Design, setting and participantsThis population-based cohort study, conducted in Sweden during the period 1997-2010, included all patients with a first diagnosis of myocardial infarction in the Swedish nationwide myocardial infarction register SWEDEHEART (n=209592). Exposure was defined as a diagnosis of SMI (i.e. bipolar disorder or schizophrenia) in the national patient register prior to infarction. Bias-minimized logistic regression models were identified using directed acyclic graphs and included covariates age, gender, smoking, diabetes, previous cardiovascular disease, myocardial infarction characteristics and treatment. Main outcome measuresThe outcomes were 30-day and 1-year mortality, obtained through linkage with national population registers. ResultsPatients with bipolar disorder (n=442) and schizophrenia (n=541) were younger (mean age 68 and 63years, respectively) than those without SMI (n=208609; mean age 71years). The overall 30-day and 1-year mortality rates were 10% and 18%, respectively. Compared with patients without SMI, patients with SMI had higher 30-day [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.55-2.56] and 1-year mortality (OR 2.11, 95% CI 1.74-2.56) in the fully adjusted model. The highest mortality was observed amongst patients with schizophrenia (30-day mortality: OR 2.58, 95% CI 1.88-3.54; 1-year mortality: OR 2.55, 95% CI 1.98-3.29). ConclusionSMI is associated with a markedly higher mortality after myocardial infarction, also after accounting for contributing factors. It is imperative to identify the reasons for this higher mortality.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Keyword

bipolar disorder
cardiovascular disease
epidemiology
mortality
schizophrenia

Publication and Content Type

ref (subject category)
art (subject category)

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By the author/editor: Boden, Robert; Molin, E.; Jernberg, T.; Kieler, H.; Lindahl, Bertil; Sundström, Johan

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Health Sciences; and Public Health Gl ...

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By the university: Uppsala University; Karolinska Institutet

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