Key result
MetS status yields only fair agreement with Framingham risk models in psychiatric outpatients.
Why the study?
Patients with mental illness have increased cardiovascular risk, but different CVR-assessment methods used by psychiatrists and GPs may yield unequal risk predictions.
Do different cardiovascular risk assessment methods yield equal risk predictions in psychiatric outpatients?
Cross-Sectional (n=4,257)
Yes
Do different cardiovascular risk assessment methods yield equal risk predictions in psychiatric outpatients?
Effect estimate: κ = 0.23-0.28 (95% CI 0.18-0.38)
p-value: p=<0.036
Different cardiovascular risk assessment methods yield unequal risk predictions in psychiatric outpatients, highlighting the potential need for population-specific recalibrated models.
CVR methods yield inconsistent predictions in psychiatric outpatients; leaves open optimal model selection and supports psychiatric-specific recalibration.
BACKGROUND: Patients with a mental illness are more likely to develop, and die from, cardiovascular diseases (CVD), necessitating optimal CVD-risk (CVR)-assessment to enable early detection and treatment. Whereas psychiatrists use the metabolic syndrome (MetS)-concept to estimate CVR, GPs use absolute risk-models. Additionally, two PRIMROSE-models have been specifically designed for patients with severe mental illness. We aimed to assess the agreement in risk-outcomes between these CVR-methods. METHODS: To compare risk-outcomes across the various CVR-methods, we used somatic information of psychiatric outpatients from the PHAMOUS-, and MOPHAR-database, aged 40-70 years, free of past or current CVD and diabetes. We investigated: (1) the degree-of-agreement between categorical assessments (i.e. MetS-status vs. binary risk-categories); (2) non-parametric correlations between the number of MetS-criteria and absolute risks; and (3) strength-of-agreement between absolute risks. RESULTS: Seven thousand twenty-nine measurements of 3509 PHAMOUS-patients, and 748 measurements of 748 MOPHAR-patients, were included. There was systematic disagreement between the categorical CVR-assessments (all p < 0.036). Only MetS-status versus binary Framingham-assessment had a fair strength-of-agreement (κ = 0.23-0.28). The number of MetS-criteria and Framingham-scores, as well as MetS-criteria and PRIMROSE lipid-scores, showed a moderate-strong correlation (τ = 0.25-0.34). Finally, only the continuous PRIMROSE desk and lipid-outcomes showed moderate strength-of-agreement (ρ = 0.91). CONCLUSIONS: The varying methods for CVR-assessment yield unequal risk predictions, and, consequently, carry the risk of significant disparities regarding treatment initiation in psychiatric patients. Considering the significantly increased health-risks in psychiatric patients, CVR-models should be recalibrated to the psychiatric population from adolescence onwards, and uniformly implemented by health care providers. TRIAL REGISTRATION: The MOPHAR research has been prospectively registered with the Netherlands Trial Register on 19th of November 2014 (NL4779).
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Quadackers et al. (2023) conducted a cross-sectional in Severe mental illness / Psychiatric disorders (n=4,257). Cardiovascular risk assessment methods vs. Between-method agreement was evaluated on Agreement between categorical cardiovascular risk assessments (MetS-status vs. binary Framingham-assessment) (κ = 0.23-0.28, 95% CI 0.18-0.38, p=<0.036). Cardiovascular risk assessment methods yielded unequal risk predictions in psychiatric outpatients, with only fair agreement between metabolic syndrome status and binary Framingham assessment (κ = 0.23-0.28).
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