Diagnostic-mortality discordance in ischaemic heart disease among patients with schizophrenia: A systematic review and meta-analysis.
Jianxiang Wang, Rita Brekke, Morten A Høydal
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In 30 seconds
This systematic review and meta-analysis examined observational evidence on ischaemic heart disease (IHD) risk, diagnosis, and mortality among people with schizophrenia. Across 62 studies, 33 of which contributed to meta-analysis, IHD mortality was higher than in the general population (standardised mortality ratio 2·26, 95 % CI 1·85-2·76; p < 0·001), while the association with IHD diagnostic incidence was weaker (hazard ratio 1·40, 95 % CI 1·00-1·97; p = 0·052). The authors describe this contrast as diagnostic-mortality discordance, with relative mortality burden concentrated in younger adults with conventionally low risk scores.
Key findings
- IHD mortality was elevated versus the general population (SMR 2·26, 95 % CI 1·85-2·76; p < 0·001; I²=98·5 %).
- The association with IHD diagnostic incidence was weaker (hazard ratio 1·40, 95 % CI 1·00-1·97; p = 0·052).
- Elevated IHD mortality was reported in females (SMR 2·57, 2·00-3·29) and males (SMR 2·25, 1·84-2·75).
- Within-study comparisons concentrated relative IHD mortality burden in adults younger than 50 years with conventionally low risk scores.
Why it matters
The divergence between mortality and recorded diagnosis raises concern that conventional risk assessment and diagnostic pathways may not capture IHD burden adequately in schizophrenia. This matters because missed or delayed recognition could leave substantial cardiovascular risk unaddressed, and the review highlights younger adults and women as groups in whom risk may be underestimated.
What to keep in mind
The evidence came from observational studies, and heterogeneity in the pooled IHD mortality estimate was very high (I²=98·5 %).