Clinical decision support system reduces cardiovascular risk in patients with serious mental illness

Press release

Monday, March 7, 2022

The low-effort system informs health professionals about patients’ cardiovascular risk factors.

In a new study, researchers have shown that they can significantly reduce the cardiovascular risk of patients with severe mental illness (SMI) by using a clinical decision support system that prompts clinicians to provide individualized information brochures on a patient’s cardiovascular risk and treatment recommendations. The findings suggest that the use of clinical decision support systems to drive the use of shared decision-making tools, such as handouts, may have a positive impact on long-term cardiovascular health in patients with SMI.

The study, supported through a cooperative agreement with the National Institutes of Health, appears in the journal Open JAMA Network.

“This landmark study is one of the first randomized controlled trials to improve cardiovascular health in a large US population of outpatients with SMI. Primary care practices caring for patients with SMI now have a practical tool to address one of the leading causes of premature mortality for these patients,” said Susan T. Azrin, Ph.D., chief of the Mortality Research Program Premature in SMI at the National Institute of Mental Health.

Cardiovascular disease is a leading cause of death among people diagnosed with SMI, a collective term that refers to schizophrenia, schizoaffective disorder, and bipolar disorder. The higher rate of cardiovascular disease in people with SMI is due in part to higher rates of smoking, obesity, diabetes, and dyslipidemia. Additionally, medications sometimes used to treat SMI can increase cardiometabolic risk due to their effect on weight, insulin resistance, and lipid metabolism.

In this study, researchers led by Dr Rebecca RossomPrincipal Investigator at the HealthPartners Institute in Minneapolis examined whether the use of a clinical decision support system to help provide individualized cardiovascular risk information could reduce this risk and improve cardiovascular health in adult patients with SMI.

The study included 76 primary care clinics that were part of three health care systems serving patients in Minnesota, North Dakota and Wisconsin. Healthcare sites were randomly assigned to an intervention (42 clinics) or control (34 clinics) group. Participants at the control and intervention sites included nearly 9,000 patients between the ages of 18 and 75 years who were diagnosed with SMI and had at least one cardiovascular risk factor that was not in a healthy target range. Clinics in the intervention group used a clinical decision support system to prompt their health workers to print and distribute shared decision-making booklets for patients and physicians that included individualized information about patients’ cardiovascular risk and possible outcomes. treatment considerations.

“Patient and physician impressions were intended to become shared decision-making tools to help patients understand their risks and help physicians quickly elicit patient preferences to address those risks,” said Dr. Rossom. “We designed the shared decision-making tools to minimize any disruption to clinic workflow and give primary care physicians an overview of a patient’s cardiovascular risk and recommended actions at a glance.”

The investigators evaluated modifiable cardiovascular risk factors for 12 months after the patient’s initial visit. They found that patients at intervention sites had an overall lower 4% increase in modifiable cardiovascular risk compared with patients at control sites. The researchers found no significant impacts on any modifiable risk factors. Instead, they found that a combination of changes in risk factors seemed to drive the reduction in total risk.

“While the difference in modifiable cardiovascular risk due to the intervention may seem small at 4%, it is clinically significant and translates into the potential prevention of three heart attacks or strokes per 1,000 patients with SMI,” said Dr. Rossom. “In my medical group alone, we have over 30,000 SMI patients, so we could prevent up to 90 heart attacks or strokes with this intervention. Other than that, we don’t know what benefits might be gained by continuing this intervention for longer than the 12 months we studied it.”

Changes in risk factors were most pronounced for those with bipolar disorder, followed by those with schizoaffective disorder, and then those with schizophrenia. While the intervention worked equally well for men and women, it was more effective for younger and middle-aged patients (18-29 years old and 50-59 years old). The intervention was found to benefit patients who identify themselves as black or white, but not patients who identify as Asian, Native American, Hispanic, or other or unknown race.

The findings suggest that the use of a low-load clinical decision support system to drive the use of shared decision-making tools, such as the handouts used in this study, may result in changes in treatment and style. of life that have a greater impact on long-term cardiovascular health. health in people with SMI.

Subsidies: MH092201

About the National Institute of Mental Health (NIMH): NIMH’s mission is to transform the understanding and treatment of mental illness through basic and clinical research, paving the way for prevention, recovery, and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH):NIH, the nation’s medical research agency, includes 27 institutes and centers and is a component of the U.S. Department of Health and Human Services. NIH is the lead federal agency conducting and supporting basic, clinical, and translational medical research , and is researching the causes, treatments, and cures for common and rare diseases. For more information about the NIH and its programs, visit www.nih.gov.

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