Schizophrenia cardiovascular risk under-recognized in primary care

UK researchers have found that despite being a major contributor to premature deaths among patients with schizophrenia, cardiovascular disease is less likely to be recorded on their primary care records than those of people without schizophrenia.

"This suggests a systematic under-recognition and undertreatment of cardiovascular disease of people with schizophrenia within primary care, which might contribute to the substantial cardiovascular-related morbidity and premature mortality observed in this patient group," say authors Daniel Smith (University of Glasgow, UK) and colleagues.

Their study included data on 9677 people with schizophrenia or related non-organic psychosis and 1,414,701 controls, registered with general practices in Scotland.

As expected, the authors found that patients with schizophrenia had significantly higher rates of comorbidities, such that they were 21% more likely to have one comorbidity, 37% more likely to have two comorbidities, and 19% more likely to have three or more comorbidities than controls.

Of the 32 most common chronic physical health conditions in the database, viral hepatitis (0.4 vs 0.2%), constipation (9.0 vs 2.5%), and Parkinson's disease (0.8 vs 0.2%) had the highest prevalence in patients with schizophrenia compared with controls, at a 4.0-, 3.2-, and 3.1-fold increase in odds, respectively.

But, while the most commonly diagnosed condition for individuals with schizophrenia was hypertension (16.0%), this was still lower than the rate in controls (16.5%). The authors calculate that patients with schizophrenia were 29% less likely to have a record of hypertension than patients without, and were also 38%, 25%, and 17% less likely to have a record of atrial fibrillation, coronary heart disease, and peripheral vascular disease, respectively.

They also note that patients with schizophrenia had significantly higher rates of diabetes, chronic obstructive pulmonary disease, epilepsy, dyspepsia, liver disease, irritable bowel syndrome, and chronic pain than controls.

"In keeping with several recent reports, this study highlights that multiple physical-health comorbidity is a major issue for people with schizophrenia and related psychoses," the authors write in BMJ Open.

They suggest that patients with schizophrenia may be less aware of cardiovascular disease risk and associated symptoms, or may be less likely to have their cardiovascular health investigated. Additionally, there is evidence that patients with mental illness may not receive the same level of attention for their physical problems as patients without mental illness, which may include less frequent blood pressure monitoring, the authors note.

Smith and colleagues say that their findings highlight the need for integrated care of patients with schizophrenia between primary and specialist services in the UK, as well as other countries.

They add: "Given that cardiovascular risk assessment has been shown to be acceptable to many people with psychosis, a more systematic use of such screening in both primary and secondary care may improve early detection and treatment of hypertension, hypercholesterolaemia, diabetes and smoking."

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