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Inequalities in the primary care of patients with coronary heart disease and serious mental health problems: a cross-sectional study
  1. Julia Hippisley-Cox1,
  2. Chris Parker2,
  3. Carol Coupland1,
  4. Yana Vinogradova1
  1. 1
    Division of Primary Care, University of Nottingham, Nottingham, UK
  2. 2
    Nottingham Primary Care Research Partnership, Nottingham, UK
  1. Professor J Hippisley-Cox, Division of Primary Care, University of Nottingham, University Park, Nottingham NG7 2RD, UK; julia.hippisley-cox{at}


Objective: To determine whether UK patients with coronary heart disease (CHD) who also have schizophrenia or bipolar disorder are less likely to receive primary care in accordance with the agreed national standards of the UK than patients without these mental health problems.

Design: Cross-sectional study.

Setting: 485 UK general practices contributing anonymised medical records of over 3.26 million patients to the QRESEARCH database.

Participants: 127 932 patients with CHD of whom 701 had a diagnosis of schizophrenia or bipolar disorder.

Main outcome measures: The relative risks of receiving statin medication and each of the CHD care indicators defined in the UK General Medical Services contract, for patients with schizophrenia or bipolar disorder compared with patients with neither condition. The results were adjusted for age, sex, deprivation, diabetes, stroke and smoking status, and allowed for clustering by practice.

Results: Patients with schizophrenia were 15% less likely to have a recent prescription for a statin (95% CI 8% to 20%) and 7% less likely to have a recent record of cholesterol level (95% CI 3% to 11%). There were no significant differences in the adjusted analyses between mental health groups on recording smoking status, advising on smoking cessation, recording blood pressure, achieving target blood pressure or cholesterol values, or prescribing aspirin, antiplatelets, anticoagulants or β blockers.

Conclusions: Although the majority of CHD care indicators are achieved equally for patients who also have a serious mental health problem, there is a shortfall in identifying and treating raised cholesterol among patients with schizophrenia, despite their higher level of risk factors.

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  • Funding: This study was supported by the Disability Rights Commission. The sponsor was involved in defining the initial research question but had no involvement in the study design, the extraction, analysis of data, the writing of the report, or the decision to submit the paper for publication. JH-C, CC and YV are core-funded university staff, CP received NHS R&D support funding.

  • Competing interests: None.

  • Ethics approval was granted by Trent MREC (reference 05/MRE04/47).

  • All authors contributed to the study design, analysis plan, and manuscript. In addition, JH-C initiated the study, obtained ethical approval, supervised the data extraction and is the study guarantor.

  • Abbreviations:
    coronary heart disease
    General Medical Services
    Veterans Health Administration