Kelly Fleetwood, John Nolan, Colin Berry, Debbie Cavers, Stewart W Mercer, Sandosh Padmanabhan, Daniel J Smith, Robert Stewart, Amanda Vettini, Caroline A Jackson, on behalf of the CVD-COVID-UK/COVID-IMPACT Consortium
Severe mental illness (SMI), which includes schizophrenia, bipolar disorder and major depression, affects about one in ten people. People with SMI die 10-20 years sooner than people without SMI (Fleetwood et al. 2025, Hjorthoj et al. 2017). This is mainly due to poorer physical health, in particular a higher risk of cardiovascular disease (CVD), including myocardial infarction (MI) (Ajetunmobi et al. 2013, Correll et al. 2017).
After an MI, people with SMI are more likely to die than those without SMI (Chan et al. 2022). The reasons for this are not well understood, but they are likely to be multifactorial, with systemic disparities in diagnosis, clinical investigation and treatment in primary and secondary care settings thought to be an important contributory factor (Firth et al. 2019). With respect to management of MI in the early post-event period, receipt of coronary revascularisation has been most studied, with lower rates observed in those with SMI (Schulman-Marcus et al. 2016, Shao et al. 2020, Fleetwood et al. 2021). However, detailed understanding of how and why acute care for MI differs by SMI status is lacking. Furthermore, we do not know whether any differences in delivery of care after an MI have been affected by the COVID-19 pandemic. It is important to investigate this, to inform responses to this now and in future situations where disruptions of care occur.
This protocol describes the methods used to examine SMI and receipt of acute cardiac care following myocardial infarction.
References:
- Ajetunmobi O, Taylor M, Stockton D, Wood R. Early death in those previously hospitalised for mental healthcare in Scotland: a nationwide cohort study, 1986-2010. BMJ Open. 2013;3:e002768. doi: https://doi.org/10.1136/bmjopen-2013-002768
- Chan JKN, Chu RST, Hung C, Law JWY, Wong CSM, Chang WC. Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull 2022;48:981-998. doi: https://doi.org/10.1093/schbul/sbac070
- Correll CU, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large‐scale meta‐analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 2017;16:163–180. doi: https://doi.org/10.1002/wps.20420
- Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry 2019;6:675–712. doi: https://doi.org/10.1016/S2215-0366(19)30132-4
- Fleetwood K, Wild SH, Smith DJ, Mercer SW, Licence K, Sudlow CLM, et al. Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study. BMC Med 2021;19:67. doi: https://doi.org/10.1186/s12916-021-01937-2
- Fleetwood KJ, Alotaibi R, Scheuer SH, Smith DJ, Wild SH, Jackson CA. Time trends in life expectancy of people with severe mental illness in Scotland, 2000-2019: population-based study. BJPsych Open 2025;11:e103. doi: https://doi.org/10.1192/bjo.2025.49
- Hjorthoj C, Sturup AE, McGrath JJ, Nordentoft M. Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry. 2017;4:295–301. doi: https://doi.org/10.1016/S2215-0366(17)30078-0
- Schulman-Marcus J, Goyal P, Swaminathan RV, Feldman DN, Wong SC, Singh HS, et al. Comparison of Trends in Incidence, Revascularization, and In-Hospital Mortality in ST-Elevation Myocardial Infarction in Patients With Versus Without Severe Mental Illness. Am J Cardiol 2016;117:1405–1410. doi: https://doi.org/10.1016/j.amjcard.2016.02.006
- Shao M, Zhuo C, Gao X, Chen C, Xu Y, Tian H, et al. Reduced rate of revascularization in schizophrenic patients with acute myocardial infarction: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020;99:109870. doi: https://doi.org/10.1016/j.pnpbp.2020.109870
Preprint available here: https://doi.org/10.1101/2025.11.21.25340556
- View the analysis code used in NHS England's SDE for England
- View the phenotyping algorithms and codelists used in NHS England's SDE for England
This is a sub-project of project CCU046 approved by the CVD-COVID-UK / COVID-IMPACT Approvals & Oversight Board (sub-project: CCU046_01).
Licensed under the Apache License, Version 2.0 (the "License"); you may not use this software except in compliance with the License. You may obtain a copy of the License at http://www.apache.org/licenses/LICENSE-2.0. Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.
