Risk of heart failure in patients with schizophrenia or bipolar disorder: A systematic review and meta-analysis

Abstract

Background and Objective: Individuals with schizophrenia and bipolar disorder experience excess cardiovascular morbidity and premature mortality; however, the specific risk of incident heart failure has not been comprehensively quantified. We conducted a systematic review and meta-analysis to evaluate the risk of heart failure in these populations.

Methodology: A search was conducted on PubMed, Embase, Scopus, and Web of Science databases from inception through February 10, 2026, with no language restrictions, for cohort studies that reported adjusted estimates of the risk of incident heart failure in patients with schizophrenia or bipolar disorder. Random-effects meta-analyses were performed to obtain risk ratio (RR). Heterogeneity was assessed using the I² statistic.

Results: Seven retrospective cohort studies met the inclusion criteria. Schizophrenia was associated with a significantly increased risk of incident heart failure (RR: 1.50, 95% CI 1.35–1.67; I² = 74.9%). Bipolar disorder was associated with an even greater risk (RR: 1.95, 95% CI 1.31–2.91; I² = 80.1%). The direction of association was consistent across studies, and sensitivity analyses confirmed the robustness of pooled estimates.

Conclusions: Both schizophrenia and bipolar disorder are independently associated with substantially elevated risks of incident heart failure. High heterogeneity in the meta-analysis warrants caution in interpreting the results.