People with serious mental illness under-prescribed heart and stroke medication

People with serious mental illness are less likely to receive life-saving heart and stroke drugs than the general population, despite being at increased risk of cardiovascular disease, according to a new study.

Those who live with conditions such as schizophrenia and bipolar disorder have a lower life expectancy than the general population, and it is thought that high rates of cardiovascular disease may be partially responsible for this.  

But until now it has not been possible to link specialist secondary mental health records and primary physical health records to confirm whether people with serious mental illness known to secondary mental health services and diagnosed with cardiovascular diseases are receiving the same treatment as the general population.

National Institute for Health Research (NIHR)-supported researchers used CRIS (Clinical Record Interactive Search) – a health records database with text-mining technology – to compare the anonymised medical records of more than 4,000 people with serious mental illness with records from some 27,0000 people in the general population.

Among the general population, 68% of people who had experienced heart failure or coronary heart disease received beta blockers, and 77% had received ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs). But among people with serious mental illness, the proportion was substantially lower – 53% received beta blockers, and 64% received ACEI or ARB drugs.

It is possible that low rates of cardiovascular drug prescribing might be attributable to people with serious mental illness seeing their doctor less frequently. However, the researchers found that people with serious mental illness usually have frequent medical consultations, and even after the results were adjusted to account for different rates of consultations, the disparity in cardiovascular drug prescribing remained.  

The findings, published in the British Journal of General Practice, suggest that a substantial proportion of people with serious mental illness are not receiving adequate treatment for heart and circulatory problems, which could be contributing to their lower life expectancy.

Professor Matthew Hotopf, director of the NIHR Maudsley Biomedical Research Centre, and one of the paper’s authors, said: “Our study clearly highlights the disadvantage suffered by people with mental disorders in terms of cardiovascular health management. It’s not clear why people with severe mental illness are being prescribed heart and stroke drugs less often than the general population – it could be that doctors are concerned about whether patients can stick to another course of drugs, since they’ll very often already be on medication for their mental illness. 

“Whatever the reason, this is part of a wider problem of poor physical healthcare in people with severe mental illness. In addition to improving our understanding of the disparities in medical treatment between people with severe mental illness and the general population, it’s clear that we need to foster closer working links between general and specialist medical staff, to ensure that people with severe mental illness are receiving the medical care that they need.”