Objective:

This study used meta-analysis to assess disparities in cardiovascular disease (CVD) screening and treatment in people with mental disorders, a group that has elevated CVD incidence and mortality.

Methods:

The authors searched PubMed and PsycInfo through July 31, 2020, and conducted a random-effect meta-analysis of observational studies comparing CVD screening and treatment in people with and without mental disorders. The primary outcome was odds ratios for CVD screening and treatment. Sensitivity analyses on screening and treatment separately and on specific procedures, subgroup analyses by country, and by controlling for confounding by indication, as well as meta-regressions, were also run, and publication bias and quality were assessed.

Results:

Forty-seven studies (N=24,400,452 patients, of whom 1,283,602 had mental disorders) from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening or treatment in patients with mental disorders emerged for any CVD (k=47, odds ratio=0.773, 95% CI=0.742, 0.804), coronary artery disease (k=34, odds ratio=0.734, 95% CI=0.690, 0.781), cerebrovascular disease (k=8, odds ratio=0.810, 95% CI=0.779, 0.842), and other mixed CVDs (k=11, odds ratio=0.839, 95% CI=0.761, 0.924). Significant disparities emerged for any screening, any intervention, catheterization or revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and with specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and they differed across countries. Median study quality was high (Newcastle-Ottawa Scale score, 8); higher-quality studies found larger disparities, and publication bias did not affect results.

Conclusions:

People with mental disorders, and those with schizophrenia in particular, receive less screening and lower-quality treatment for CVD. It is of paramount importance to address underprescribing of CVD medications and underutilization of diagnostic and therapeutic procedures across all mental disorders.

中文翻译：

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全球精神障碍患者心血管疾病筛查和治疗的差异：47 项观察性研究的系统回顾和荟萃分析

客观的：

本研究使用荟萃分析来评估精神障碍患者心血管疾病 (CVD) 筛查和治疗的差异，这是一个心血管疾病发病率和死亡率升高的群体。

方法：

作者搜索了截至 2020 年 7 月 31 日的 PubMed 和 PsycInfo，并对比较有和没有精神障碍的人的 CVD 筛查和治疗的观察性研究进行了随机效应荟萃分析。主要结果是心血管疾病筛查和治疗的优势比。还对单独的筛查和治疗以及特定程序、国家亚组分析以及通过适应症控制混杂因素以及元回归进行了敏感性分析，并对发表偏倚和质量进行了评估。

结果：

来自北美 (k=26)、欧洲 (k=16)、亚洲 (k=4) 和澳大利亚 (k=1) 的 47 项研究（N=24,400,452 名患者，其中 1,283,602 名患有精神障碍）是 meta-分析了。对于任何 CVD（k=47，优势比=0.773，95% CI=0.742，0.804）、冠状动脉疾病（k=34，优势比=0.734，95% CI），精神障碍患者的筛查或治疗率均较低=0.690, 0.781)、脑血管疾病 (k=8, 比值比=0.810, 95% CI=0.779, 0.842) 和其他混合性心血管疾病 (k=11, 比值比=0.839, 95% CI=0.761, 0.924)。在冠状动脉疾病的任何筛查、任何干预、导管插入术或血运重建、卒中静脉溶栓以及所有精神障碍中使用任何和特定药物治疗 CVD（心境障碍中的 CVD 药物除外）的治疗中都出现了显着差异。精神分裂症的差异最大，并且在不同国家之间存在差异。研究质量中位数高（纽卡斯尔-渥太华量表评分，8）；更高质量的研究发现更大的差异，并且发表偏倚不会影响结果。

结论：

精神障碍患者，尤其是精神分裂症患者，接受的心血管疾病筛查较少，治疗质量较低。解决所有精神障碍中 CVD 药物处方不足以及诊断和治疗程序使用不足的问题至关重要。