How well do we perform in monitoring the physical health of patients on antipsychotics?

Dr Ameer Khan, Dr Harry Large

Background

Monitoring cardiovascular parameters is important for people who are on antipsychotics. This is because antipsychotics can have an impact on the cardiovascular system, leading to an increased risk of cardiovascular events such as heart attack and stroke.

The National Institute for Health and Care Excellence (NICE) provides guidance on the monitoring of cardiovascular parameters for people who are on antipsychotics in CG178. According to NICE, healthcare providers should monitor blood pressure and heart rate at the initiation of treatment and then periodically throughout treatment. They should also consider additional monitoring for people who are at increased risk of cardiovascular events, such as those who have a history of cardiovascular disease or who are taking other medications that can affect the cardiovascular system. Additionally, NICE also recommends that healthcare providers consider the use of metabolic monitoring for people who are on antipsychotics, as the use of these medications can lead to weight gain and metabolic changes. This includes monitoring of body weight, glucose, and lipids at the initiation of treatment and then periodically throughout treatment. The guidance also recommend that healthcare providers should consider switching to an antipsychotic with a lower risk of metabolic side effects for people who are at high risk of metabolic problems or who are experiencing significant weight gain or metabolic changes.

Annual monitoring of cardiovascular parameters are recommended as per the guidance

This includes annual recording of :

•weight (plotted on a chart) waist circumference pulse and blood pressure annually

Aims

To see our compliance rate to the NICE guidance of the annual monitoring for patients on antipsychotics and their cardiovascular parameters

To revise our practice to ensure we comply with national guidance so that we continue in our provision of high-quality care and to integrate new technology to allow efficient monitoring.

Methods

The audit cycle was conducted for the period beginning 31st of December 2021 until 31st of December 2022. All data was collected retrospectively and was collected across one general practice in the Tameside area

All patients who were on antipsychotics including were included in this data search, these included all antipsychotics licensed as per the British National Formulary. Data collected included whether weight, waist, pulse rate, blood pressure, fasting glucose, HbA1c, lipid profile, prolactin, any movement disorders, diet assessment, and ECG.

NICE Clinical guidance CG 178 was used as a reference for this audit

A snapshot of second cycle was then conducted in February 2023 which showed a significant increase in compliance to the guidance with an over 90% request rate for all relevant tests to measure the annual cardiovascular parameters

An electronic automatic template was generated using the GP EMIS system that would generate an alert for healthcare professionals to be aware that patients

Results

• A total of 28 patients were identified that met our criteria for the audit

These patients were found to be on antipsychotics namely: aripiprazole, chlorpromazine, quetiapine, flupentixol, risperidone, sulpiride & olanzapine

• Mean age was 54.89

• 15 females & 13 males

• 3 patients had dedicated antipsychotic medication monitoring appointments

• 50% had weight/BMI recorded

• Pulse and blood pressure were 61% and 68% respectively

• No prolactin and no ECG for any patients

Discussion

Studies have shown that patients taking antipsychotics are at a higher risk of developing cardiovascular disease compared to individuals not taking these medications. This is because antipsychotics can have an impact on several biological factors that are associated with cardiovascular disease, such as lipid levels, insulin resistance, and inflammation.

• This increased incidence of cardiovascular disease in patients taking antipsychotics is not only a concern for the health and well-being of the patients but also for the financial burden it places on the National Health Service (NHS) in the United Kingdom. Cardiovascular disease is one of the leading causes of death and disability globally, and the cost of treating these conditions can be substantial. The NHS spends billions of pounds each year on treating cardiovascular disease, which puts a significant strain on the healthcare system.

• Resources are stretched within primary care however prevention is a critical aspect of public health, as it can lead to improved health outcomes, reduced health disparities, cost-effectiveness, and sustainability

Learning points/ Take home message

• In an era where public health has become ever more important, it is vital that all preventative measures are adopted to ensure that we reduce the incidence of iatrogenic illnesses. The ever increasing awareness of a mental health will mean that more patients will be prescribed treatments that may involve antipsychotic use.

• It is vital that we monitor these patients parameters closely so that the physical health is maintained and we continue to provide holistic patient centred care and integrate new technology to enable efficient use of time and resources.

References https://www.nice.org.uk/guidance/cg178/chapter/Recommendations