General practice interventions to reduce cardiovascular disease risk in patients with severe mental illness: A...

People with severe mental illness (SMI), including bipolar disorder, major depression, and schizophrenia, face significantly increased morbidity and mortality from cardiovascular disease (CVD). Common CVD risk factors in these populations comprise health behaviours such as smoking and poor diet, and physical factors, including diabetes mellitus, obesity and dyslipidaemia. Thus, there is a need to identify interventions to prevent CVD in SMI patients, for which general practice may be ideal for delivery. This scoping review aimed to explore the interventions to reduce CVD risk in patients with SMI in primary care, with a focus on general practice.

This scoping review was guided by Arksey and O'Malley's six-step methodological framework, barring step six - consultation. A systematic search was performed across four electronic databases: PubMed, Embase, APA PsycINFO and CINAHL, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Narrative synthesis was conducted to identify key themes informed by the Popay et al. framework.

A total of 10 studies were included in the final analysis. Five themes were identified, namely (1) Primary Care Interventions, (2) Intervention Implementation, (3) Collaborative or Intermediary Structures, (4) Barriers and Facilitators, and (5) Participant Experiences and Viewpoints. Identified intervention types included tailored behavioural change interventions, the patient centred medical home model, clinical tool use and provider education. Promising aspects of interventions included effective staff training, collaborative structures and peer support involvement. Challenges to implementation included patient mental health symptoms impacting ability to attend sessions, lack of knowledge and experience among staff of working with SMI patients, and resource constraints, including time and workload concerns.

This scoping review highlights a research gap regarding primary care interventions to reduce CVD risk in SMI patients, as only 10 relevant studies were identified published from 2015 to July 2025 in the English language. However, aspects of existing literature, such as promising intervention features, implementation barriers and feedback for consideration were also identified. Future research regarding this topic could address identified barriers and feedback points. Further randomised controlled trials assessing clinical-effectiveness and cost-efficiency of interventions in primary care settings may also be required.