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Cardiovascular risk in high secure environments
Professor Julia Hippisley-CoxUniversity of Nottingham
West London Mental Health Trust Clinical staff at three hospitals R&D and MREC EMIS TPP Vision QResearch
Acknowldegments
Compare CVD risk factor recording and CVD risk in SEMI patients in each of the 3 hospitals with SEMI patients in QResearch
Objectives
NICE PH15 - identify & reduce risk premature mortality
NICE CG68 - identify & reduce CVD risk DRC enquiry -poor physical health of
patients with SEMI
Background
Community patients with SEMI Higher risk of CHD Higher levels risk factors
◦ smoking◦ obesity◦ diabetes
Less likely to be offered interventions Less likely to report symptoms Less likely to take prescribed medicines Less likely to reach targets for lipids
Key findings DRC report:
Lipid modification guidelines Identify patients at increased CVD risk Quantify increased risk using QRISK2 or
similar Modify risk factors
◦ weight loss◦ Blood pressure control◦ Lipid control◦ Smoking cessation
NICE guidelines (2008, CG67)
Comparison of CVD Risk in four groups with SEMI1. Broadmoor hospital - EMIS2. Rampton hospital3. Ashworth hospital4. QResearch – community sample
R&D and MREC approval Extraction of pseudoymised patient level
data
New study 2012
Age Chronic renal disease
Sex Diabetes
Ethnicity Hypertension
Smoking status CHD/stroke
Body mass index Medication but not recorded systematically in any of the hospitals
Lipids
Systolic blood pressure
Rheumatoid arthritis
Data items collected
Recording of family historylower in hospital
Hospital A 9% Hospital B 3%Hospital C 4%QResearch 14%
Variation in recording of ethnicity
Large variation
Hospital A 48% Hospital B 0%Hospital C 97%QResearch 84%
Recording of body mass index
Generally higher and more recent in hospital patients
Obesity levels very highOver half all hospital patients obese c.f. 29% in QResearch
Type 2 Diabetes also very high
One in 5 hospital patients have diabetesTwice as high as community5 times as high as non-SEMI
Diabetes by ageMarked risk with increasing age – 29% patients over 50 have diabetes
Fasting blood glucose testingHuge variation in FBS testing but doesn’t explain high prevalence of diabetes in all hospital settings
SBP control < 150/90Overall most patients meeting BP targets
Cholesterol < 5 mmol/lOverall many patients meeting cholesterol targetsBetter than QResearch
Recording 7 QOF SEMI register
Patients with QOF code for SEMI have higher risk factor recording ratese.g. 87% with QOF code have glucose recorded cf 37% without QOF code
QResearch no SEMI
QResearch SEMI
HospitalSEMI
<10% risk 91.2 83.8 83.5
10-19.9% risk
7.1 12.2 12.0
20%+ risk 1.7 4.0 4.6
CVD risk resultsHospital patients more than twice as likely to have high CVD risk compared with community patients
Some good examples of recording Some variation between the three hospital Twice the CVD risk c.f. general population More than half have obesity One in five have diabetes Diabetes twice as high as SEMI in
community Diabetes five times as high as general
population
Summary: hospital vs community
Recommendation 1: urgent need to commission services for
weight loss including diet, exercise & medication review
Recomendation 2: Interventions to lower diabetes riskRecommendation 3: Use of QOF SEMI codes to identify patients
and make use of computer QOF audit facilities
Summary recommendations
Hospitals to use GP computer system for prescribing
1. Identify patients on medication for monitoring (eg lithium)
2. Identify patients not on medication who need it (eg statins)
3. use of inbuilt safety alerts in computer systems eg for drug interactions
4. Data for research into medication effects
Recommendation4
Use of computer templates to improve recording of family history
All patients to have ethnicity recorded Update records for smoking status Identify patients with high glucose values
but without diagnosis of diabetes recorded
Recommendations 5-8
Report published at www.qresearch.org Any questions
Thank you for listening
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