A new Scottish study published online in Europe’s leading cardiology journal, the European Heart Journal, explains that men and women hospitalized for chest pain unrelated to heart disease with a history of psychiatric illness have a higher death rate than individuals without prior mental health problems.
The authors found that the death rate one year after hospitalization for non-cardiac chest pain (NCCP) was higher in individuals who had previously been hospitalized for mental health problems, compared with those who had not, with cardiovascular disease being responsible for the majority of deaths amongst patients with previous psychiatric hospitalization.
Dr. Michelle Gillies, Clinical Lecturer in Epidemiology, at the University of Glasgow, Glasgow, UK, explained:
“We found that men and women with a prior psychiatric hospitalization were younger, more socioeconomically deprived and more likely to be suffering from diabetes or hypertension that those without a prior psychiatric hospitalization.
Even after adjusting for these differences we found that the rate of death at one year from any cause and from cardiovascular disease was higher in men and women with a previous psychiatric hospitalization than without, with the excess risk being greatest in younger patients.”
The team identified more than 150,000 men and women, without existing heart disease, hospitalized for the first time for non-cardiac chest pain between 1991 and 2006 by using routinely collected hospital admission data from the Scottish National Health Service. Out of the 150,000 individuals, 3,514 (4.4%) men and 3,136 (3.9%) women had a prior hospitalization for mental health problems in the past decade.
The researchers wrote that one year following hospital discharge for NCCP there were more deaths among individuals with a prior psychiatric hospitalization – 6.3% in men and 5.3% in women – compared to patients without – 4.3% in men and 3.6% in women. The most prevalent cause of death was cardiovascular disease, accounting for 28.2% of all deaths in men and 44.1% of all deaths in women who had a prior psychiatric hospitalization.
Dr. Gillies states:
“Our findings are consistent with previous studies that have shown that patients with psychiatric illness have a greater risk of heart-related problems and are at a greater risk of death than the general population. In our study patients with psychiatric illness were at excess risk of death relative to the rest of the study population, despite having been assessed by hospital physicians for chest pain.
A hospitalization for chest pain is a valuable opportunity to engage this difficult-to reach population, assess cardiovascular risk and intervene to reduce risk.
Our study highlights the need to carefully assess all patients who are admitted to hospital with chest pain and suggests that current approaches to this assessment may be less effective in patients with psychiatric illness. Further studies to understand why this is so, are required. We would urge clinicians to carefully assess cardiovascular risk in all patients with psychiatric illness, a view supported by a recent joint position statement issued by the European Psychiatric Association and European Society of Cardiology.”
In an associated report, Bertram Pitt, Professor of Internal Medicine at the University of Michigan School of Medicine (Michigan, USA), said:
“The initial episode of psychiatric hospitalization or possibly the diagnosis of psychiatric illness rather than the first episode of NCCP should be the time to consult a cardiologist, and the stimulus for intensive cardiac evaluation and risk factor control to prevent the development of coronary artery disease and its consequences.
While the exact mechanisms linking a prior psychiatric hospitalization and a first hospitalization for NCCP to increased cardiovascular and total mortality remain uncertain, we are indebted to Dr Gillies et al. for pointing out the increased cardiovascular risk and the need for cardiovascular evaluation of these patients.
The increasing evidence that both vascular disease and psychiatric illnesses such as anxiety and depression share common mechanisms suggests challenges and opportunities for both the psychiatrist and the cardiologist to improve risk detection and to prevent cardiovascular and total mortality in patients with psychiatric illnesses both with and without NCCP. . . . This will, however, require a further understanding of the links between psychiatric illness and cardiovascular disease as well as prospective evaluation.”
Adapted from an article written by Kay Roche
Written by Grace Rattue