The British Journal of Psychiatry (2009) 195: 545-550. doi: 10.1192/bjp.bp.109.067082
© 2009 The Royal College of Psychiatrists
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Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare

Stephen Kisely, MD, MSc

University of Queensland, Brisbane, Australia and Dalhousie University, Halifax, Nova Scotia, Canada

Leslie Anne Campbell, BScN, MSc

Health Outcomes Research Unit, Capital District Health Authority, Halifax, Nova Scotia, Canada

Yan Wang, MCS

Population Health Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada

Correspondence: Correspondence: Stephen Kisely, Room 518(A), McGregor Building (No 64), Queensland Centre for Health Data Services, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia. Email: s.kisely{at}uq.edu.au

Declaration of interest

None.

Background

Most data on the quality of vascular care for individuals with psychiatric conditions come from countries without universal healthcare.

Aims

To investigate the treatment of people with psychosis admitted for ischaemic heart disease or stroke under universal healthcare.

Method

A population-based study of administrative data comparing Canadians with and without a history of schizophrenia or related psychosis (n = 65 039).

Results

Of 49 248 admissions for ischaemic heart disease, 1285 had a history of psychosis. Despite a higher 1-year mortality, they were less likely to receive guideline-consistent treatment: e.g. coronary artery bypass grafting (adjusted odds ratio (OR) = 0.35, 95% CI 0.25–0.48), beta-blockers (adjusted OR = 0.82, 95% CI 0.71–0.95) and statins (adjusted OR = 0.51, 95% CI 0.41–0.63). Of 15 791 admissions for stroke, 594 had a history of psychosis. Despite higher 1-year mortality rates, they were less likely to receive cerebrovascular arteriography or warfarin.

Conclusions

People with a history of psychosis do not receive equitable levels of vascular care under universal healthcare.


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