Guideline adherence for cardiometabolic monitoring of patients prescribed antipsychotic medications in primary care: a retrospective observational study

Abstract

Background: Despite their known effectiveness, antipsychotics possess significant cardiometabolic adverse event profiles. Guidelines emphasise routine monitoring, however, practices are known to be suboptimal.

Aim: To investigate the level of cardiometabolic monitoring among people prescribed antipsychotic therapy in primary care, and patient-related factors that may influence monitoring patterns.

Method: Data were collected for patients with mental disorders and prescribed antipsychotics at two general practices in England (February 2016-February 2021). The main outcome measures were the proportion of patients with evidence of monitoring for cardiometabolic parameters (body composition, anthropometrics, lipids, glucose outcomes). Regression analysis was used to explore factors predicting monitoring practices.

Results: Data from 497 patients were included. The proportion of patients receiving cardiometabolic monitoring at least once yearly varied across different parameters. Patients were mostly monitored for BP (92.0%), body weight (BMI > 85.0%) and HDL (72.0%), but to a lesser extent for other lipid parameters (non-HDL < 2.0%) and blood glucose (< 2.0%). Ageing (OR:2.0-7.0, p < 0.001) and chronic conditions (e.g., CVD and Type 2 DM, p < 0.05) were associated with frequent cardiometabolic monitoring. Conversely, antipsychotics with high metabolic risks (olanzapine), patients prescribed antipsychotic polypharmacy (≥ 2 antipsychotics) and cardiometabolic dysregulations (e.g., dyslipidaemias) did not improve monitoring frequencies.

Conclusion: Cardiometabolic health monitoring was generally infrequent, irregular, and did not change in response to abnormal test results or antipsychotic treatment with high cardiometabolic risks, suggesting more efforts need to be made to ensure the guidelines for cardiometabolic monitoring are followed. Future studies should investigate practices by using a large UK primary care database.

Keywords: Antipsychotics; Cardiometabolic monitoring; Mental disorders; Observational study; Primary care.

Fig. 1

Selection process for patients’ records. APs: antipsychotics. Created by BioRender.com [13]

Fig. 2

Overall monitoring density for cardiometabolic testing of patients receiving antipsychotic medication in the last 3-years (A) Cardiometabolic monitoring density for body compositions and blood pressure (B), and lipid profiles (C) by different indications. Abbreviations: BMI body mass index, WC waist circumference, BP blood pressure, HBA1C glycosylated haemoglobin, HDL high-density lipoprotein, non-HDL non high-density lipoprotein, AP antipsychotic, CVD cardiovascular diseases, DM diabetes mellitus. Data represent the proportion (%) of monitored participants. Exposure characteristics: AP-only: Antipsychotic drug only (no other comorbidities), Antipsychotic with pre-existing comorbidities (CVD or DM or both)