Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcare

Background: Most data on the quality of vascular care for individuals with psychiatric conditions come from countries without universal healthcare. Aims: To investigate the treatment of people with psychosis admitted for ischaemic heart disease or stroke under universal healthcare. Method: A population-based study of administrative data comparing Canadians with and without a history of schizophrenia or related psychosis (n=65 039). Results: Of 49248 admissions for ischaemic heart disease, 1285 had a history of psychosis. Despite a higher 1-year mortality, they were less likely to receive guideline-consistent treatment: e.g. coronary artery bypass grafting (adjusted odds ratio (OR)=0.35, 95% CI 0.25-0.48), beta-blockers (adjusted OR=0.82, 95% CI 0.71-0.95) and statins (adjusted OR=0.51, 95% CI 0.41-0.63). Of 15791 admissions for stroke, 594 had a history of psychosis. Despite higher 1-year mortality rates, they were less likely to receive cerebrovascular arteriography or warfarin. Conclusions: People with a history of psychosis do not receive equitable levels of vascular care under universal healthcare.