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Systematic computerised cardiovascular health screening for people with severe mental illness

  • David Yeomans (a1), Kate Dale (a2) and Kate Beedle (a3)

Abstract

Aims and method

People with severe mental illness (SMI) die relatively young, with mortality rates four times higher than average, mainly from natural causes, including heart disease. We developed a computer-based physical health screening template for use with primary care information systems and evaluated its introduction across a whole city against standards recommended by the National Institute for Health and Care Excellence for physical health and cardiovascular risk screening.

Results

A significant proportion of SMI patients were excluded from the SMI register and only a third of people on the register had an annual physical health check recorded. The screening template was taken up by 75% of GP practices and was associated with better quality screening than usual care, doubling the rate of cardiovascular risk recording and the early detection of high cardiovascular risk.

Clinical implications

A computerised annual physical health screening template can be introduced to clinical information systems to improve quality of care.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

David Yeomans (david.yeomans@nhs.net)

Footnotes

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Declaration of interest

The authors have provided a single paid consultation to another primary care organisation that has used the template.

Footnotes

References

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Systematic computerised cardiovascular health screening for people with severe mental illness

  • David Yeomans (a1), Kate Dale (a2) and Kate Beedle (a3)
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eLetters

Cardiovascular screening in severe mental illness still awaits an evidence base

Steve Brown, Consultant Psychiatrist
04 January 2015

I welcome any contribution that might improve the shocking mortality disadvantage associated with severe mental illness (SMI). Yeomans et al (1) should however be aware that this issue was identified long before the 1990s. William Farr reported in 1841 that the mortality of lunatics in England and Wales varied between three and fourteen times that of the general population (2). He concluded that some of the excess deaths 'may be fairly ascribed to insanity. The excess above this must be attributed to the diseases generated by the limited space in which the unhappy lunatics are confined - to the collection of large numbers under the same roof - the impurity of atmosphere - the want of exercise and warmth - the poor unvaried diet - and the deficiency of medical attendance'. Plus ca change.

While it is positive that the excess natural mortality of mental illness is attracting greater attention we should be wary of blindly jumping onto the cardiovascular screening bandwagon. There is no evidence that health checks improve the mortality of the general population (3). People with SMI are a high risk group for cardiovascular disease and thus their risk benefit balance may be different. But screening takes resourcesthat could be used for other interventions and has harmful consequences for significant numbers of patients.

Rather than setting up huge cardiovascular screening programmes we might do better to put far more effort into smoking cessation work and to review our prescribing practice and avoid those drugs with particularly bad metabolic profiles. At the very least we need far better audit of these programmes - audit that measures whether they improve mortality.

References:

1. Yeomans D, Dale K, Beedle K. Systemic cardiovascular screening in severe mental illness. Psychiatr Bull 2014; 38:280-284.

2. Farr W. Report on the mortality of lunatics. J R Stat Soc 1841, IV, 17-33.

3. Gotzsche P, Jorgensen K, Krogsboll L. General health checks don't work. BMJ 2014;348:g36802014

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Conflict of interest: I have received lecture fees from Lundbeck for presentations on physical health in severe mental illness.

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