Disparity in Care and CVD Cuts Life Expectancy 25 Years for Patients with Mental Illnesses

Newswise — While death from cardiovascular disease (CVD) has markedly declined in the U.S. during the past several decades, a commentary by a researcher at Florida Atlantic University (FAU) published in the October 17 issue of the Journal of the American Medical Association (JAMA) shows that patients with severe mental illnesses such as schizophrenia, bipolar disorder and depression lose an average of 25 years or more of life expectancy due largely to CVD and disparity in care.

"While suicide is a key factor in the cause of death in these patients, it is important to note that CVD accounts for far more premature deaths in this patient population," said Charles H. Hennekens, M.D., Sir Richard Doll Research Professor in the Charles E. Schmidt College of Biomedical Science at FAU.

The commentary delineates the disparities in CVD mortality and prevention efforts comparing the general population and individuals with severe mental illnesses.

Some of the key findings are:

"¢Patients with severe mental illness who experience an acute myocardial infarction were significantly less likely than the general population to receive drug therapies with proven benefits such as thrombolytics, aspirin, beta blockers and ACE inhibitors.

"¢These patients were also significantly less likely to undergo cardiac catheterizations and receive emergency angioplasties or coronary artery bypass graft surgery.

"¢A study of 88,000 Medicare patients hospitalized for myocardial infarctions showed a 19% increase in mortality during the follow-up period for patients with any mental disorder and a 34% increase in mortality for patients with schizophrenia.

"¢The prevalence of diabetes, dyslipidemia (elevation of plasma cholesterol), hypertension and obesity are also 1.5 to 2 times more prevalent in patients with severe mental illness than in the general population.

"¢Patients with diabetes and severe mental illness are less likely than patients with diabetes and no mental illness to receive standard-of-care treatment. In general, screening for hyperglycemia and dyslipidemia occur at very low rates in individuals with serious mental disorders despite the National Cholesterol Education Program's recommended guidelines for aggressive treatment for diabetic patients.

"¢Fifty to 80 percent of patients with diagnosable mental illness are smokers and consume 34 to 44 percent of all cigarettes in the U.S. In contrast, in the general population, smoking rates have declined from more than 50 percent in the 1950s to approximately 25 percent today. Cigarette consumption has been the leading avoidable cause of all premature deaths, representing a key measure of risk. In some states, tobacco-dependence treatment is not covered for disabled patients with fixed incomes, and only a few states cover all treatments recommended in the U.S. Preventive Services Task Force guidelines on smoking cessation.

"¢A study of more than 300,000 patients with diabetes in the Veterans Administration system showed that patients with mental illnesses like schizophrenia and bipolar disorder had a significantly increased risk of not receiving appropriate elements of care, such as eye examinations, plasma lipid testing and glycated hemoglobin monitoring.

"The data clearly indicate that there is a crucial need for new approaches to prevention and treatment of cardiovascular disease in patients with severe mental illnesses," said Hennekens. "In the general U.S. population, during the last decade, most of the observed reductions in deaths due to cardiovascular disease are a result of improvements in the treatment of acute events such as heart attacks and in particular, long-term treatment and prevention efforts."

A recent Institute of Medicine report concerning the need to improve overall healthcare for patients with mental illnesses emphasized the importance of integrating and co-localizing psychiatric and medical services.

"Efforts to improve the disparity in the care and treatment of CVD in individuals with severe mental illnesses must include better education and involvement of primary care physicians, cardiologists, endocrinologists and psychiatrists," said Hennekens. "We have to be more aggressive in monitoring, identifying and reducing risk in this patient population. Without future collaborative efforts, the large burden of avoidable premature mortality from CVD in these patients is likely to continue and increase in magnitude and severity."

"The exciting work by Dr. Hennekens underscores even more than ever the need for the medical community to be aware of the cardiovascular problems of patients with mental illnesses and to be as aggressive as possible in their treatment," said Dr. Michael Friedland, vice president for medical programs and dean of the Charles E. Schmidt College of Biomedical Science at FAU. "FAU is working on the cutting edge of this issue through the continued efforts of Dr. Hennekens and his colleagues."

According to the National Institute of Mental Health about six percent or 1 in 17 Americans suffer from a serious mental illness including schizophrenia, bipolar disorder and depression. In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44, and many people suffer from more than one mental disorder at a given time.

Florida Atlantic University opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 26,000 undergraduate and graduate students on seven campuses strategically located along 150 miles of Florida's southeastern coastline. Building on its rich tradition as a teaching university, with a world-class faculty, FAU hosts nine colleges: College of Architecture, Urban & Public Affairs, Dorothy F. Schmidt College of Arts & Letters, the Charles E. Schmidt College of Biomedical Science, the Barry Kaye College of Business, the College of Education, the College of Engineering & Computer Science, the Harriet L. Wilkes Honors College, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science.