Department of Medicine, Division of General Internal Medicine University of Toronto Canada.
ICES Toronto Canada.
J Am Heart Assoc. 2024 Aug 6;13(15):e035589. doi: 10.1161/JAHA.124.035589. Epub 2024 Jul 26.
People with schizophrenia are less likely than those without to be treated for cardiovascular disease. We aimed to evaluate the association between schizophrenia and secondary preventive care after ischemic stroke.
In this retrospective cohort study, we used linked population-based administrative data to identify adults who survived 1 year after ischemic stroke hospitalization in Ontario, Canada between 2004 and 2017. Outcomes were screening, treatment, and control of risk factors, and receipt of outpatient physician services. We used modified Poisson regression to model the relative risk of each outcome among people with and without schizophrenia, adjusting for age and other factors. Among 81 163 people with ischemic stroke, 844 (1.04%) had schizophrenia. Schizophrenia was associated with lower rates of screening for hyperlipidemia (60.5% versus 66.0%, adjusted relative risk [aRR] 0.88 [95% CI, 0.84-0.93]) and diabetes (69.4% versus 73.9%, aRR 0.93 [95% CI, 0.89-0.97]), prescription of antihypertensive medications (91.2% versus 94.7%, aRR 0.96 [95% CI, 0.93-0.99]), achievement of target lipid levels (low-density lipoprotein <2 mmol/L) (30.6% versus 34.6%, aRR 0.86 [95% CI, 0.78-0.96]), and outpatient specialist visits (55.3% versus 67.8%, aRR 0.78 [95% CI, 0.74-0.83]) or primary care physician visits (94.5% versus 98.5%; aRR 0.96 [95% CI, 0.95-0.98]) within 1 year. There were no differences in prescription of antilipemic, antiglycemic, or anticoagulant medications, or in achievement of target hemoglobin A1c ≤7%.
People with stroke and schizophrenia are less likely than those without to receive secondary preventive care. This may inform interventions to improve poststroke care and outcomes in those with schizophrenia.
与非精神分裂症患者相比，精神分裂症患者接受心血管疾病治疗的可能性较低。我们旨在评估精神分裂症与缺血性卒中后二级预防护理之间的关系。
在这项回顾性队列研究中，我们使用基于人群的行政数据进行链接，以确定 2004 年至 2017 年期间在加拿大安大略省缺血性卒中住院后存活 1 年的成年人。结果是筛选、治疗和控制危险因素以及接受门诊医生服务。我们使用修正泊松回归模型来评估精神分裂症患者与非精神分裂症患者之间每种结局的相对风险，同时调整年龄和其他因素。在 81163 例缺血性卒中患者中，844 例（1.04%）患有精神分裂症。与非精神分裂症患者相比，精神分裂症患者的血脂异常筛查率较低（60.5%比 66.0%，调整后的相对风险[ARR]0.88[95%CI，0.84-0.93]）和糖尿病（69.4%比 73.9%，ARR 0.93[95%CI，0.89-0.97]）、降压药物处方（91.2%比 94.7%，ARR 0.96[95%CI，0.93-0.99]）、达到目标血脂水平（低密度脂蛋白<2mmol/L）（30.6%比 34.6%，ARR 0.86[95%CI，0.78-0.96]）和门诊专科医生就诊率（55.3%比 67.8%，ARR 0.78[95%CI，0.74-0.83]）或初级保健医生就诊率（94.5%比 98.5%，ARR 0.96[95%CI，0.95-0.98]）在 1 年内。抗脂药、抗糖药或抗凝药的处方以及目标血红蛋白 A1c≤7%的达标率无差异。
与非精神分裂症患者相比，患有中风和精神分裂症的患者接受二级预防护理的可能性较低。这可能为改善精神分裂症患者的卒中后护理和结局提供信息。
