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January 1, 2023Epidemiology and Psychiatric SciencesOpen Access

In-hospital mortality and cardiovascular treatment during hospitalization for heart failure among patients with schizophrenia: a nationwide cohort study

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Key result

Schizophrenia links to ~96% higher in-hospital mortality and fewer cardioprotective meds in young HF patients.

  • OR 1.96
  • 95% CI 1.24-3.10
  • P=0.0037
  • n=704,193

Why the study?

There is limited knowledge regarding in-hospital prognosis and quality of care for patients with schizophrenia hospitalized for heart failure.

Does comorbid schizophrenia increase in-hospital mortality and reduce the prescription of cardioprotective medications in patients hospitalized with heart failure?

Population

704,193 patients hospitalized with HF in Japan

Comparison

Patients with schizophrenia vs without schizophrenia

Design

Nationwide registry-based cohort study

Authors

MNMasahiro NishiASAkira ShikumaTSTomotsugu Seki

Discussion

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Member takes

Overview

May support closer monitoring in young HF patients with schizophrenia; leaves open whether closing GDMT gaps improves survival.

Study Design

Type

Cohort (n=704,193)

Multicenter

Yes

Structured PICO

Does comorbid schizophrenia increase in-hospital mortality and reduce the prescription of cardioprotective medications in patients hospitalized with heart failure?

P
Population
704,193 patients aged ≥18 to 85 years admitted with acute or chronic heart failure as a primary diagnosis across 1,065 hospitals in Japan. Stratified by age: young (>18 to 45 years, n=20,289), middle (>45 to 65 years, n=114,947), and old (>65 to 85 years, n=568,957).
I
Intervention
Comorbid schizophrenia (ICD-10 codes F20-29)
C
Comparator
No comorbid schizophrenia
O
Outcome
All-cause and 30-day in-hospital mortalityhard clinical

Main Result

Effect estimate: OR 1.96 (95% CI 1.24-3.10)

Absolute Event Rate: 7.6% vs 3.5%

p-value: p=0.0037

Comorbid schizophrenia is an independent risk factor for in-hospital mortality and is associated with significantly lower prescription rates of guideline-directed medical therapies in non-elderly patients hospitalized with heart failure.

Limitations

  • The data did not include laboratory data
  • HF types were not classified by ejection fraction (EF)
  • The data did not encompass the cause of death
  • The severity of schizophrenia was not examined
  • Data did not include laboratory data
  • Heart failure types were not classified by ejection fraction (EF)
  • Data did not encompass the cause of death
  • Severity of schizophrenia was not examined

Cite This Study

Nishi et al. (2023) conducted a cohort in Heart failure (n=704,193). Schizophrenia vs. Without schizophrenia was evaluated on All in-hospital mortality (young adults aged 18-45 years) (OR 1.96, 95% CI 1.24-3.10, p=0.0037). Schizophrenia was associated with significantly higher in-hospital mortality (OR 1.96) and reduced prescription of cardioprotective medications in young adult patients hospitalized with heart failure.

synapsesocial.com/papers/6a154e2b37103a43379f87dchttps://doi.org/10.1017/s2045796023000744
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Association of Secondary Preventive Cardiovascular Treatment After Myocardial Infarction With Mortality Among Patients With Schizophrenia2018 · 103 citations
  2. 2Mortality and Revascularization among Myocardial Infarction Patients with Schizophrenia: A Population-Based Cohort Study2020 · 21 citations
  3. 3Clinical Heart Failure Among Patients With and Without Severe Mental Illness and the Association With Long-Term Outcomes2021 · 29 citations
  4. 4Association Between Patient Volume to Cardiologist, Process of Care, and Clinical Outcomes in Heart Failure2023 · 4 citations
  5. 5Severe Mental Illness and Cardiovascular Disease2022 · 234 citations