What is the clinical evidence from this study?

Study design: Cohort. Population: Mental illness (Schizophrenia and mood disorders) (n=11435). Intervention: Antipsychotic drugs. Primary outcome: Complete cardiometabolic monitoring at recommended time points over 1 year.

September 9, 2023Open Access

Cardiometabolic screening and monitoring in patients prescribed antipsychotic drugs in primary care: A population-based cohort study

Key Result

In UK primary care, only approximately 2.0% of patients prescribed antipsychotic drugs received complete cardiometabolic monitoring according to guidelines over a one-year period.

Study Design

Type

Cohort (n=11,435)

Multicenter

Yes

Structured PICO

Population

11,435 adult patients with mental illness prescribed antipsychotic therapy in UK primary care, followed for one year to assess adherence to cardiometabolic monitoring guidelines.

Exposure

Antipsychotic medication (first-generation or second-generation)

Outcome

Frequency (proportion in %) of cardiometabolic monitoring (body composition, blood pressure, blood glucose, and lipid profile) at baseline, 6 weeks, 12 weeks, and 12 months

Cardiometabolic monitoring practices for patients prescribed antipsychotics in UK primary care remain highly suboptimal, highlighting a critical gap in guideline adherence.

Limitations

Some patients using antipsychotics may be solely managed in secondary care, which may not be reflected in the primary care database.
Subject to misclassification bias or under-recording of eligible patients.
Potential antipsychotic switching during the study period and the possibility of drug selection bias.
Confounding from other psychotropic medications (e.g., antidepressants, mood stabilizers) that can contribute to metabolic side effects.
Data related to smoking history and alcohol drinking habits were not available for extraction.

Abstract

BACKGROUND: This study aimed to investigate the level of guideline adherence for cardiometabolic health monitoring for patients prescribed antipsychotic medicines in UK primary care. METHODS: In this population-based retrospective open cohort study, we used dataset of patients from the IQVIA Medical Research Data (IMRD) database between 1st January 2003 to 31st December 2018. Clinical Read codes were used to identify a cohort of adult patients with a diagnosis of Schizophrenia and at least four prescriptions of an anti-psychotic medication within 12 months of diagnosis. We then extracted data in relation to monitoring of cardiometabolic parameters (body compositions, lipids, and glucose outcomes) at baseline, then at six weeks, 12 weeks, and then 12 months. The frequency of outcome monitoring was described using descriptive statistics. FINDINGS: A total of 11,435 patients were eligible and of them (n = 9707; 84·8%) were prescribed second-generation antipsychotics (SGAs). Only a small portion of the cohort (≈2·0%) received complete monitoring (at time points) for certain outcomes. Just over half the patients (n = 6599, 52%) had evidence of any cardiometabolic baseline testing for any of the study outcomes and the high majority had at least one abnormal lab value at baseline (n = 4627, 96·7%). INTERPRETATION: In UK primary care, cardiometabolic monitoring practices among patients prescribed antipsychotics remain suboptimal. There is a need to promote guideline adherence to prevent adverse outcomes in antipsychotic users.

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Cite This Study

Ali et al. (Sat,) conducted a cohort in Mental illness (Schizophrenia and mood disorders) (n=11,435). Antipsychotic drugs was evaluated on Complete cardiometabolic monitoring at recommended time points over 1 year. In UK primary care, only approximately 2.0% of patients prescribed antipsychotic drugs received complete cardiometabolic monitoring according to guidelines over a one-year period.

synapsesocial.com/papers/6a1ec33d544bdf605faf4021 https://doi.org/https://doi.org/10.1016/j.comppsych.2023.152419

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