Polcwiartek Christoffer, Loewenstein Daniel, Friedman Daniel J, Johansson Karin G, Graff Claus, Sørensen Peter L, Nielsen René E, Kragholm Kristian, Torp-Pedersen Christian, Søgaard Peter, Jensen Svend E, Jackson Kevin P, Atwater Brett D
Division of Cardiology, Duke University Medical Center, Durham, NC (C.P., D.L., K.P.J., B.D.A.).
Department of Cardiology (C.P., K.K., C.T.-P., P.S., S.E.J.), Aalborg University Hospital, Denmark.
Circ Heart Fail. 2021 Oct;14(10):e008364. doi: 10.1161/CIRCHEARTFAILURE.121.008364. Epub 2021 Sep 30.
Patients with severe mental illness (SMI) including schizophrenia, bipolar disorder, and severe depression have earlier onset of cardiovascular risk factors, predisposing to worse future heart failure (HF) compared with the general population. We investigated associations between the presence/absence of SMI and long-term HF outcomes.
We identified patients with HF with and without SMI in the Duke University Health System from 2002 to 2017. Using multivariable Cox regression, we examined the primary outcome of all-cause mortality. Secondary outcomes included rates of implantable cardioverter defibrillator use, cardiac resynchronization therapy, left ventricular assist device implantation, and heart transplantation.
We included 20 906 patients with HF (SMI, n=898; non-SMI, n=20 008). Patients with SMI presented clinically 7 years earlier than those without SMI. We observed an interaction between SMI and sex on all-cause mortality (=0.002). Excess mortality was observed among men with SMI compared with men without SMI (hazard ratio, 1.36 [95% CI, 1.17-1.59]). No association was observed among women with and without SMI (hazard ratio, 0.97 [95% CI, 0.84-1.12]). Rates of implantable cardioverter defibrillator use, cardiac resynchronization therapy, left ventricular assist device implantation, and heart transplantation were similar between patients with and without SMI (6.1% versus 7.9%, =0.095). Patients with SMI receiving these procedures for HF experienced poorer prognosis than those without SMI (hazard ratio, 2.12 [95% CI, 1.08-4.15]).
SMI was associated with adverse HF outcome among men and not women. Despite equal access to procedures for HF between patients with and without SMI, those with SMI experienced excess postprocedural mortality. Our data highlight concurrent sex- and mental health-related disparities in HF prognosis, suggesting that patients with SMI, especially men, merit closer follow-up.
患有严重精神疾病（SMI）的患者，包括精神分裂症、双相情感障碍和重度抑郁症患者，与普通人群相比，心血管危险因素的发病时间更早，未来发生心力衰竭（HF）的风险更高。我们研究了有无SMI与长期HF结局之间的关联。
我们在杜克大学医疗系统中确定了2002年至2017年期间患有和未患有SMI的HF患者。使用多变量Cox回归，我们检查了全因死亡率的主要结局。次要结局包括植入式心脏复律除颤器的使用、心脏再同步治疗、左心室辅助装置植入和心脏移植的发生率。
我们纳入了20906例HF患者（SMI组，n = 898；非SMI组，n = 20008）。患有SMI的患者临床发病时间比未患有SMI的患者早7年。我们观察到SMI与性别在全因死亡率方面存在交互作用（P = 0.002）。与未患有SMI的男性相比，患有SMI的男性死亡率更高（风险比，1.36 [95% CI，1.17 - 1.59]）。在患有和未患有SMI的女性中未观察到关联（风险比，0.97 [95% CI，0.84 - 1.12]）。患有和未患有SMI的患者植入式心脏复律除颤器的使用、心脏再同步治疗、左心室辅助装置植入和心脏移植的发生率相似（6.1% 对 7.9%，P = 0.095）。因HF接受这些治疗的SMI患者的预后比未患有SMI的患者差（风险比，2.12 [95% CI，1.08 - 4.15]）。
SMI与男性而非女性的不良HF结局相关。尽管患有和未患有SMI的患者获得HF治疗的机会均等，但患有SMI的患者术后死亡率更高。我们的数据突出了HF预后中与性别和心理健康相关的并发差异，表明患有SMI的患者，尤其是男性，值得更密切的随访。
