Cardiovascular disease treatment among patients with severe mental illness: a data linkage study between primary and secondary care

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Abstract

Background

Suboptimal treatment of cardiovascular diseases (CVD) among patients with severe mental illness (SMI) may contribute to physical health disparities.

Aim

To identify SMI characteristics associated with meeting CVD treatment and prevention guidelines.

Design and setting

Population-based electronic health record database linkage between primary care and the sole provider of secondary mental health care services in south east London, UK.

Method

Cardiovascular disease prevalence, risk factor recording, and Quality and Outcomes Framework (QOF) clinical target achievement were compared among 4056 primary care patients with SMI whose records were linked to secondary healthcare records and 270 669 patients without SMI who were not known to secondary care psychiatric services, using multivariate logistic regression modelling. Data available from secondary care records were then used to identify SMI characteristics associated with QOF clinical target achievement.

Results

Patients with SMI and with coronary heart disease and heart failure experienced reduced prescribing of beta blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEI/ARB). A diagnosis of schizophrenia, being identified with any indicator of risk or illness severity, and being prescribed with depot injectable antipsychotic medication was associated with the lowest likelihood of prescribing.

Conclusion

Linking primary and secondary care data allows the identification of patients with SMI most at risk of undertreatment for physical health problems.

Related collections

Most cited references 42

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Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care.

Marc De Hert, Christoph U. Correll, Julio Bobes … (2011)

The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.

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The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers

David Lawrence, Kirsten Hancock, Stephen Kisely (2013)

Objective To examine the mortality experience of psychiatric patients in Western Australia compared with the general population. Design Population based study. Setting Western Australia, 1985-2005. Participants Psychiatric patients (292 585) registered with mental health services in Western Australia. Main outcome measures Trends in life expectancy for psychiatric patients compared with the Western Australian population and causes of excess mortality, including physical health conditions and unnatural causes of death. Results When using active prevalence of disorder (contact with services in previous five years), the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005. Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%). Suicide was the cause of 13.9% of excess deaths. Conclusions Despite knowledge about excess mortality in people with mental illness, the gap in their life expectancy compared with the general population has widened since 1985. With most excess deaths being due to physical health conditions, public efforts should be directed towards improving physical health to reduce mortality in people with mental illness, in addition to ongoing efforts to prevent suicide.

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The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data

Robert Stewart, Mishael Soremekun, Gayan Perera … (2009)

Background Case registers have been used extensively in mental health research. Recent developments in electronic medical records, and in computer software to search and analyse these in anonymised format, have the potential to revolutionise this research tool. Methods We describe the development of the South London and Maudsley NHS Foundation Trust (SLAM) Biomedical Research Centre (BRC) Case Register Interactive Search tool (CRIS) which allows research-accessible datasets to be derived from SLAM, the largest provider of secondary mental healthcare in Europe. All clinical data, including free text, are available for analysis in the form of anonymised datasets. Development involved both the building of the system and setting in place the necessary security (with both functional and procedural elements). Results Descriptive data are presented for the Register database as of October 2008. The database at that point included 122,440 cases, 35,396 of whom were receiving active case management under the Care Programme Approach. In terms of gender and ethnicity, the database was reasonably representative of the source population. The most common assigned primary diagnoses were within the ICD mood disorders (n = 12,756) category followed by schizophrenia and related disorders (8158), substance misuse (7749), neuroses (7105) and organic disorders (6414). Conclusion The SLAM BRC Case Register represents a 'new generation' of this research design, built on a long-running system of fully electronic clinical records and allowing in-depth secondary analysis of both numerical, string and free text data, whilst preserving anonymity through technical and procedural safeguards.

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Author and article information

Contributors

Charlotte Woodhead: Role: Research associate

Mark Ashworth: Role: Reader in primary care

Matthew Broadbent: Role: Clinical informatics lead

Matthew Hotopf: Role: Professor in general hospital psychiatry

Peter Schofield: Role: Research fellow

Robert J Stewart: Role: Professor of psychiatric epidemiology and clinical informatics

Max J Henderson: Role: Senior lecturer

Journal

Journal ID (nlm-ta): Br J Gen Pract

Journal ID (iso-abbrev): Br J Gen Pract

Journal ID (publisher-id): bjgp

Title: The British Journal of General Practice

Publisher: Royal College of General Practitioners

ISSN (Print): 0960-1643

ISSN (Electronic): 1478-5242

Publication date (Print): June 2016

Publication date (Electronic): 26 April 2016

Publication date PMC-release: 26 April 2016

Volume: 66

Issue: 647

Pages: e374-e381

Affiliations

King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London.

Head of information governance, South London and Maudsley NHS Foundation Trust, London.

Reader in social science for medical humanities, Durham University, Centre for Medical Humanities, Durham.

King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London.

Head of information governance, South London and Maudsley NHS Foundation Trust, London.

King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London.

Author notes

Address for correspondence Charlotte Woodhead, NIHR CLAHRC North Thames, University College London, 1–19 Torrington Place, London WC1E 7HB, UK. E-mail: c.woodhead@ 123456ucl.ac.uk

Article

DOI: 10.3399/bjgp16X685189

PMC ID: 4871302

PubMed ID: 27114210

SO-VID: e4be81d6-ec68-4d35-86d8-e2d9526c4875

License:

This is an OpenAccess article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 04 November 2015

Date revision requested : 08 January 2016

Date accepted : 28 January 2016

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Cardiovascular disease treatment among patients with severe mental illness: a data linkage study between primary and secondary care

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Abstract

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Conclusion

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UCL: UN SDG 10 Reduced Inequalities

Most cited references 42

Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care.

The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers

The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data

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