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Cardiovascular risk assessment methods yield unequal risk predictions: a large cross-sectional study in psychiatric
Davy Quadackers1,2, Edith Liemburg3, Fionneke Bos3,4
1Mental Health Services Drenthe, P.O. box 30007, 9400 RA, Assen, The Netherlands. davy.quadackers@ggzdrenthe.nl.
Insights
Cardiovascular disease risk assessment methods show poor agreement in psychiatric patients, potentially delaying treatment. Recalibrating and uniformly implementing cardiovascular risk (CVR) models for this population is crucial.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Patients with mental illness face higher risks of cardiovascular diseases (CVD).
- Accurate cardiovascular risk (CVR) assessment is vital for early detection and treatment in this population.
- Current CVR assessment methods vary between psychiatrists (Metabolic Syndrome concept) and general practitioners (absolute risk models), with specialized PRIMROSE models also existing.
Purpose of the Study:
- To compare the agreement of different CVR assessment methods in psychiatric outpatients.
- To evaluate disparities in risk prediction stemming from varied CVR assessment tools.
Main Methods:
- Utilized somatic data from psychiatric outpatients (PHAMOUS and MOPHAR databases).
- Included patients aged 40-70 without prior or current CVD or diabetes.
- Assessed agreement between categorical CVR assessments (Metabolic Syndrome status vs. binary risk categories), correlations between Metabolic Syndrome criteria and absolute risks, and agreement between absolute risks.
Main Results:
- Systematic disagreement was found across categorical CVR assessments (p < 0.036).
- Fair agreement (κ = 0.23–0.28) was observed between Metabolic Syndrome status and binary Framingham assessment.
- Moderate-strong correlations (τ = 0.25–0.34) existed between Metabolic Syndrome criteria and Framingham/PRIMROSE lipid scores.
- Only continuous PRIMROSE desk and lipid outcomes showed moderate agreement (ρ = 0.91).
Conclusions:
- Discrepancies in CVR assessment methods lead to unequal risk predictions and potential treatment initiation disparities in psychiatric patients.
- Given elevated health risks, CVR models require recalibration for the psychiatric population from adolescence onwards.
- Uniform implementation of standardized CVR assessment tools by healthcare providers is recommended.
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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