Prevalence and patient characteristics associated with cardiovascular disease risk factor screening in UK primary care for people with severe mental illness: An electronic healthcare record study

Background

People with severe mental illness (SMI) are at increased risk of cardiovascular disease (CVD), and initiatives for CVD risk factor screening in the UK have not reduced disparities.

Objectives

To describe the annual screening prevalence for CVD risk factors in people with SMI from April 2000 to March 2018, and to identify factors associated with receiving no screening and regular screening.

Methods

We identified adults with a diagnosis of SMI (schizophrenia, bipolar disorder or ‘other psychosis’) from UK primary care records in Clinical Practice Research Datalink (CPRD). We calculated the annual prevalence of screening for blood pressure, cholesterol, glucose, body mass index, alcohol consumption and smoking status, using multinomial logistic regression to identify factors associated with receiving no screening and complete screening.

Results

Of 216,136 patients with SMI, 55% received screening for all six CVD risk factors at least once follow-up and 35% received all six within a one-month period. Changes in screening prevalence coincided with changes in incentivisation of screening. In 2014-2018, men, people with a diagnosis of ‘other psychoses’, or with missing ethnicity were more likely to have received no screening.

Conclusions

The low proportion of people with SMI receiving regular comprehensive CVD risk factor screening is concerning. Screening needs to be embedded as part of broad physical health checks to ensure the health needs of people with SMI are being met. If we are to improve cardiovascular health, interventions are needed where risk of receiving no screening or not receiving regular screening is highest.

What is already known on this topic

• The prevalence of CVD risk factor screening in primary care increased with the introduction of an incentivisation scheme and when incentivisation for screening for specific CVD risk factors is removed the screening decreases.

What does this study add?

• Few patients received regular screening for all six CVD risk factors considered, and both screening prevalence and risk of receiving no screening varied depending on patient characteristics.

• Only 35% of patients ever received screening for all six CVD risk factors considered in a one-month period, suggesting that screening is not often being done as part of a physical health check.

How this study might affect research, practice or policy

• Clinicians should be aware that some sub-groups of patients with SMI are less likely to receive screening, and the importance of providing screening as part of a regular, comprehensive physical health check.