title: Higher mortality after myocardial infarction in patients with severe mental illness: a nationwide cohort study.
abstract: OBJECTIVE
  The aim of this study was to explore the impact of severe mental illness (SMI) on myocardial infarction survival and determine the influence of risk factor burden, myocardial infarction severity and different treatments.
  
  
  METHODS
  This population-based cohort study, conducted in Sweden during the period 1997-2010, included all patients with a first diagnosis of myocardial infarction in the Swedish nationwide myocardial infarction register SWEDEHEART (n = 209 592). Exposure was defined as a diagnosis of SMI (i.e. bipolar disorder or schizophrenia) in the national patient register prior to infarction. Bias-minimized logistic regression models were identified using directed acyclic graphs and included covariates age, gender, smoking, diabetes, previous cardiovascular disease, myocardial infarction characteristics and treatment.
  
  
  METHODS
  The outcomes were 30-day and 1-year mortality, obtained through linkage with national population registers.
  
  
  RESULTS
  Patients with bipolar disorder (n = 442) and schizophrenia (n = 541) were younger (mean age 68 and 63 years, respectively) than those without SMI (n = 208 609; mean age 71 years). The overall 30-day and 1-year mortality rates were 10% and 18%, respectively. Compared with patients without SMI, patients with SMI had higher 30-day [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.55-2.56] and 1-year mortality (OR 2.11, 95% CI 1.74-2.56) in the fully adjusted model. The highest mortality was observed amongst patients with schizophrenia (30-day mortality: OR 2.58, 95% CI 1.88-3.54; 1-year mortality: OR 2.55, 95% CI 1.98-3.29).
  
  
  CONCLUSIONS
  SMI is associated with a markedly higher mortality after myocardial infarction, also after accounting for contributing factors. It is imperative to identify the reasons for this higher mortality.
authors.affiliation: Unit of Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden.|Centre for Pharmacoepidemiology at the Department of Medicine, Karolinska Institutet, Solna, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Bodén
authors.affiliation: Unit of Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Molin
authors.affiliation: Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: Centre for Pharmacoepidemiology at the Department of Medicine, Karolinska Institutet, Solna, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Kieler
authors.affiliation: Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Sundström
mesh_terms: D000368:Aged; D001714:Bipolar Disorder / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000401:mortality*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012559:Schizophrenia / Q000401:mortality; D016019:Survival Analysis; D013548:Sweden
keywords: bipolar disorder; cardiovascular disease; epidemiology; mortality; schizophrenia