S83. MORTALITY, REVASCULARIZATION AND CARDIOPROTECTIVE PHARMACOTHERAPY AFTER ACUTE CORONARY SYNDROME IN PATIENTS WITH PSYCHOTIC DISORDERS: A POPULATION-BASED COHORT STUDY

Abstract

Methods: This was a population-based cohort study with data retrieved from a territory-wide medical record database of public healthcare services to 7.5 million residents in Hong Kong. The study identified 67,692 patients aged ≥18 years admitted for first-recorded ACS between January 1, 2006 and December 31, 2016. The cohort was dichotomously divided by pre-ACS diagnosis of psychotic disorder. Multivariate regression (adjusted odds ratio [aOR] and 95%CI) was used to examine associations of psychotic disorders with all-cause 30-day and 1-year mortality, cardiovascular complications, 30-day and 1-year invasive cardiac procedures, and 90-day post-discharge cardioprotective medication prescription. Results: Patients with psychotic disorders (N=703) had higher 30-day (aOR=1.99, 95%CI=1.65-2.39) and 1-year (aOR=2.13, 95%CI=1.79-2.54) mortality, and cardiovascular complication rates (aOR=1.20, 95%CI=1.02-1.41), lower receipt of cardiac catheterization (30-day: aOR=0.54, 95%CI=0.43-0.68; 1-year: aOR=0.46, 95%CI=0.38-0.56), per-cutaneous coronary intervention (30-day: aOR=0.55, 95%CI=0.44-0.70; 1-year: aOR=0.52, 95%CI=0.42-0.63) and reduced β-blockers (aOR=0.81, 95%CI=0.68-0.97), statins (aOR=0.54, 95%CI=0.44-0.66), and clopidogrel prescriptions (aOR=0.66, 95%CI=0.55-0.80). Effect of psychotic disorder on heightened mortality was more pronounced in younger-aged (<65 years) and male patients. Associations between psychotic disorder and increased mortality remained significant even after complications and treatment receipt were additionally adjusted. Discussion: Psychotic disorders are associated with increased risks of short-term post-ACS mortality, cardiovascular complications and inferior treatment. Excess mortality is not substantially explained by treatment inequality. Further investigation is warranted to clarify factors for suboptimal cardiac-care and elevated mortality in psychotic disorders to enhance post-ACS outcome.