Double jeopardy for the mentally ill: higher cardiovascular risk and reduced frequency of certain interventional...

Evaluation of: Kisely S, Smith M, Lawrence D et al.: Inequitable access for mentally ill patients to some medically necessary procedures. CMAJ 176[6], 779-784 [2007]. This observational database study utilized data from three administrative databases to determine the relative effect of psychiatric disease status on mortality and utilization of in-patient procedures for cardiovascular conditions. The study results indicated that psychiatric patients exhibit significantly greater mortality compared with other groups of patients, despite adjustments for relevant socioeconomic and clinical factors. Compounding the problem, the authors further determined that cardiovascular medical procedures were underutilized in this population. This important study reveals significant public health implications for a patient population already at elevated risk for cardiovascular morbidity and mortality due to lifestyle, medical comorbidities and certain antipsychotic therapies. This study now offers supportive evidence that inequities in primary care health delivery systems provide a partial explanation for the excess cardiovascular risk observed in mentally ill patients. The widespread recognition of this issue should prompt additional research and consequent remedial action by medical providers and those institutions that support them.