Professor Julia Hippisley-Cox University of Nottingham

 West London Mental Health Trust  Clinical staff at three hospitals  R&D and MREC  EMIS  TPP  Vision  QResearch

 Compare CVD risk factor recording and CVD risk in SEMI patients in each of the 3 hospitals with SEMI patients in QResearch

 NICE PH15 - identify & reduce risk premature mortality  NICE CG68 - identify & reduce CVD risk  DRC enquiry -poor physical health of patients with SEMI

Community patients with SEMI  Higher risk of CHD  Higher levels risk factors ◦ smoking ◦ obesity ◦ diabetes  Less likely to be offered interventions  Less likely to report symptoms  Less likely to take prescribed medicines  Less likely to reach targets for lipids

 Lipid modification guidelines  Identify patients at increased CVD risk  Quantify increased risk using QRISK2 or similar  Modify risk factors ◦ weight loss ◦ Blood pressure control ◦ Lipid control ◦ Smoking cessation

 Comparison of CVD Risk in four groups with SEMI 1.Broadmoor hospital - EMIS 2.Rampton hospital 3.Ashworth hospital 4.QResearch – community sample  R&D and MREC approval  Extraction of pseudoymised patient level data

AgeChronic renal disease SexDiabetes EthnicityHypertension Smoking statusCHD/stroke Body mass indexMedication but not recorded systematically in any of the hospitals Lipids Systolic blood pressure Rheumatoid arthritis

lower in hospital Hospital A 9% Hospital B 3% Hospital C 4% QResearch 14%

Large variation Hospital A 48% Hospital B 0% Hospital C 97% QResearch 84%

Generally higher and more recent in hospital patients

Over half all hospital patients obese c.f. 29% in QResearch

One in 5 hospital patients have diabetes Twice as high as community 5 times as high as non-SEMI

Marked risk with increasing age – 29% patients over 50 have diabetes

Huge variation in FBS testing but doesn’t explain high prevalence of diabetes in all hospital settings

Overall most patients meeting BP targets

Overall many patients meeting cholesterol targets Better than QResearch

Patients with QOF code for SEMI have higher risk factor recording rates e.g. 87% with QOF code have glucose recorded cf 37% without QOF code

QResearch no SEMI QResearch SEMI Hospital SEMI <10% risk % risk %+ risk Hospital patients more than twice as likely to have high CVD risk compared with community patients

 Some good examples of recording  Some variation between the three hospital  Twice the CVD risk c.f. general population  More than half have obesity  One in five have diabetes  Diabetes twice as high as SEMI in community  Diabetes five times as high as general population

Recommendation 1:  urgent need to commission services for weight loss including diet, exercise & medication review Recomendation 2:  Interventions to lower diabetes risk Recommendation 3:  Use of QOF SEMI codes to identify patients and make use of computer QOF audit facilities

 Hospitals to use GP computer system for prescribing 1. Identify patients on medication for monitoring (eg lithium) 2. Identify patients not on medication who need it (eg statins) 3. use of inbuilt safety alerts in computer systems eg for drug interactions 4. Data for research into medication effects

 Use of computer templates to improve recording of family history  All patients to have ethnicity recorded  Update records for smoking status  Identify patients with high glucose values but without diagnosis of diabetes recorded

 Report published at  Any questions