Severe mental illness and mortality of hospitalized ACS patients in the VHA
Open accessAbstract
Background: Severe mental illness (SMI) has been associated with more medical co-morbidity and less cardiovascular procedure use for older patients with myocardial infarction. However, it is unknown whether SMI is associated with increased long term mortality risk among patients presenting with acute coronary syndromes (ACS). We tested the hypothesis that SMI is associated with higher one-year mortality following ACS hospitalization. Methods: All ACS patients (n = 14,194) presenting to Veterans Health Administration (VHA) hospitals between October 2003 and September 2005 were included. Survival analysis evaluated the association between SMI and one-year all-cause mortality, adjusting for demographics, co-morbidities, in-hospital treatment, and discharge medications. Results: Overall, 18.4 % of ACS patients had SMI. Patients with SMI were more likely female, younger, Caucasian race, have a history of alcohol abuse, liver disease, dementia, hypertension and more likely to be a current smoker; however, prior cardiac history was similar between the 2 groups. There were no significant differences in cardiac procedure use, including coronary angiogram (38.7% vs. 40.3%, p = 0.14) or coronary revascularization (31.0% vs. 32.3%, p = 0.19), and discharge medications between those with and without SMI. One-year mortality was lower for patients with SMI (15.8% vs. 19.1%, p < 0.001). However, in multivariable analysis, there were no significant differences in mortality (HR 0.91; 95% CI 0.81–1.02) between patients with and without SMI. Conclusion: Among ACS patients in the VHA, SMI is prevalent, affecting almost 1 in 5 patients. However, patients with SMI were as likely to undergo coronary revascularization and be prescribed evidence-based medications at hospital discharge, and were not at elevated risk of adverse 1-year outcomes compared to patients without SMI.
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Some studies did not find a reduction in cardiovascular drug use in schizophrenia.
“However, some studies did not find a reduction in cardiovascular drug use (Desai et al. 2002, Plomondon et al. 2007).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Plomondon et al. 2007
The Results report similar discharge prescription rates for aspirin, ACE-inhibitors/ARBs, and β-blockers in patients with and without severe mental illness. Schizophrenia was included in the severe-mental-illness group, but the reported medication comparison was for the pooled group, not for patients with schizophrenia separately. (LLM, conf=0.85)
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- Authors
- Plomondon, M. E., Ho, P. M., Wang, L., Greiner, G. T., Shore, J. H., Sakai, J. T., Fihn, S. D., & Rumsfeld, J. S.
- Affiliations
- Denver VA Medical Center (US)
- Health Services Research & Development (US)
- Corresponding author
- Plomondon, Mary E
- Venue
- BMC Health Services Research
- Published
- 2007-09-18
- Volume
- 7
- Issue
- 1
- Pages
- 146-146
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC2082028
- OpenAlex
- W2027147272
- Cited by
- 26
- References
- 21
- Citations by year
- 2025: 1 · 2022: 2 · 2021: 1 · 2019: 1 · 2018: 2 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 4 · 2012: 6
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Veterans Affairs
- Quality Enhancement Research Initiative
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- severe mental illness, acute coronary syndrome, mortality, veterans, coronary revascularization, coronary angiography, discharge medication, comorbidities, alcohol abuse
- MeSH terms
- Aged, Aged, 80 and over, Mental Disorders, Female, Health Services Research, Hospitals, Veterans, Humans, Male, Middle Aged, Myocardial Infarction, Risk Factors, United States, United States Department of Veterans Affairs, Comorbidity, Survival Analysis, Hospital Mortality, Acute Coronary Syndrome
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