Background: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.Methods: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.Results: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 (P=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%, P=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]).Conclusions: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.

中文翻译：

---

患有和不患有严重精神疾病的患者的临床心力衰竭与长期结局的关系

背景：包括精神分裂症、双相情感障碍和重度抑郁症在内的严重精神疾病 (SMI) 患者的心血管危险因素发病较早，与普通人群相比，更容易发生未来更严重的心力衰竭 (HF)。我们调查了 SMI 的存在/不存在与长期 HF 结果之间的关联。方法：我们确定了 2002 年至 2017 年杜克大学卫生系统中伴有和不伴有 SMI 的 HF 患者。使用多变量 Cox 回归，我们检查了主要结果全因死亡率。次要结局包括植入式心脏复律除颤器的使用率、心脏再同步化治疗、左心室辅助装置植入和心脏移植。结果：我们纳入了 20906 名 HF 患者（SMI，n=898；非 SMI，n=20008）。SMI 患者比没有 SMI 的患者提前 7 年出现临床症状。我们观察到 SMI 和性别对全因死亡率的影响（P = 0.002)。与没有 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]）。在患有和不患有 SMI 的女性中未观察到相关性（风险比，0.97 [95% CI，0.84–1.12]）。植入式心脏复律除颤器的使用率、心脏再同步治疗、左心室辅助装置植入和心脏移植在有和没有 SMI 的患者之间相似（6.1% 对 7.9%，P=0.095)。接受这些治疗 HF 的 SMI 患者的预后比没有 SMI 的患者差（风险比，2.12 [95% CI，1.08-4.15]）。结论：SMI 与男性而非女性的不良 HF 结局相关。尽管患有和不患有 SMI 的患者可以平等地接受 HF 手术，但患有 SMI 的患者术后死亡率过高。我们的数据突出了 HF 预后中同时存在的与性别和心理健康相关的差异，这表明 SMI 患者，尤其是男性，值得更密切的随访。