General practice professionals’ perspectives on cardiovascular risk assessment in patients diagnosed with mental health disorders: an embedded mixed-methods study

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide. Research suggests people with Mental Health Disorders (MHDs) have increased CVD risk. However, knowledge gaps exist regarding CVD risk management for general practice patients with MHD, and interventions that might improve CVD prevention. This study examined the perspectives of general practice professionals in Ireland on cardiovascular risk assessment for patients already diagnosed with MHD and to describe current approaches to identifying this population using the Mental Health Finder (MHF) tool. METHODS: An embedded mixed-methods design was adopted, guided by constructivist grounded theory and the Social Ecological Model. Aggregated anonymised data, including availability and use of the MHF tool, were collected from five practices and analysed in SPSS. In-depth semi-structured interviews were conducted with 12 general practitioners and three practice nurses. Qualitative data were analysed using Braun and Clarke's Reflexive Thematic Analysis. RESULTS: Of the five practices, two had access to the MHF tool. These reported combined prevalence of 18.7% for MHD compared with 0.5-11.5% in practices without the tool, highlighting the importance of systematic identification. Qualitative analysis generated four themes: (1) prevalence of MHD in general practice, (2) association between MHD and CVD risk, (3) CVD risk management in patients with MHD, and (4) holistic care. CONCLUSION: CVD risk assessment for patients with MHD in general practice is largely opportunistic and unstructured. Participants highlighted the need for structured frameworks, protocols, and enhanced supports to enable systematic cardiovascular assessment and management in this population.