Monitoring cardiovascular disease risk in individuals with severe mental illness in an inpatient mental health setting: a secondary data analysis

Abstract

Background/Aims Life expectancy in people with lived experience of mental health conditions is reduced by up to 25 years; this is from preventable physical medical comorbidities and multi-morbidities such as cardiovascular disease, diabetes, cancers and smoking-related lung disease. Two-thirds of these deaths are avoidable if people with severe mental illness are offered prompt physical screening checks and monitoring. The aim of this article was to explore barriers to the management of cardiovascular disease risk on inpatient wards and make recommendations in relation to cardiovascular disease risk management in people with severe mental illness. Methods A structured MS Excel extraction data tool informed by best practice guidance was developed and used to extract electronic patient data on screening and monitoring of cardiovascular disease risk factors (blood pressure, smoking, alcohol, lipids, body mass index/weight, blood glucose level) across 10 inpatient psychiatric wards within one London mental health trust. A target sample of 245 electronic records of patients with severe mental illness discharged between 25 August 2018 and 13 February 2019 with length of inpatient stay >40 days was examined. Simple random sampling (MS Excel random number generator) was used to select a final sample of 120 electronic records. All the included samples had been prescribed psychotropic medication. Results Regarding patient demographics, there was an inverse correlation with age, with a greater proportion of inpatients being of a younger age: 51% aged 18–39 years compared with 14% aged 60–79 years. The study found an average of 71% compliance of the documentation of data on all individual parameters (smoking, alcohol, body mass index, blood pressure, serum glucose, serum lipids, electrocardiogram) at baseline. Results showed an average of 79% compliance for monitoring review at least once across the parameters within 3 months of admission. Conclusions It is recommended as a minimum for individuals with severe mental illness under the care of mental health services and/or taking psychotropic medication to have regular cardiometabolic risk assessment and management of risk at the point of entry into services and a review for weight, waist circumference, blood glucose checks, lipid profile, blood pressure, lifestyle choice behaviours and personal assessment of cardiovascular disease. Although progress is being made across provider services to implement the above, gaps in practice are still evident, as demonstrated in these findings.