Inpatient Mortality, Rates of Cardiac Catheterizations, Revascularization and National Trends after Acute Myocardial Infarction in Patients with Schizophrenia and Bipolar Disorders

Objective: To investigate inpatient mortality, cardiac catheterizations, revascularization and national trends after acute myocardial infarction (AMI) in schizophrenia and bipolar disorder patients compared with the general population. Methods: Nationwide Inpatient Sample database is a stratified inpatient discharges database in the United States. Data from 2002 to 2011 was used for this study. Patients with schizophrenia and bipolar disorders who had AMI were compared with a random sample of all other adults with AMI who had no mental illness. Inpatient mortality, rates of cardiac catheterization, PCI and CABG were compared in logistic regression models after adjusting for demographic, medical risk factors, hospital properties and AMI complications. Results: From the year 2002 to 2011 a total of 1,778,915 adult patients were identified who had AMI without any psychiatric disorders. Schizophrenia (n=6212) and bipolar disorders (n=9202) patients who had AMI were identified after exclusion of other coexisting psychiatry disorders. There has been approximately a 50% decrease in STEMI and a 5% increase in NSTEMI in the general population and an approximately 50% decrease and a 30% increase in STEMI and a 10% and 200% increase in NSTEMI in schizophrenia and bipolar disorders patients respectively over the last 10 years. Patients with schizophrenia and bipolar disorders were less likely to receive catheterization, PCI and CABG (60%, 60% and 45% respectively) vs. (40%, 45% and 45% respectively) after AMI compared with controls. Inpatient mortality in schizophrenia, bipolar disorders and general population above age 76 yr was 18.54%, 12.48%, 15.24%; in between 66 yr to 75 yr it was 13.98%, 7.63% and 9.59%; in between 56 yr to 65 yr it was 10.33%, 5.09%, 6.25% and in between 46 yr to 55 yr it was 5.70%, 2.82%, 3.36% respectively. Conclusions: Schizophrenia patients with AMI had significantly higher inpatient mortality and bipolar disorders with AMI had significantly lower inpatient mortality compared with the general population. Even after adjusting for potential confounders there were significant decrease in the rates of catheterizations, PCI and CABG in patients with anxiety and depressive disorders compared with the general population.