Clinical decision support may reduce cardiovascular risk in those with severe mental illness

A recent study by the National Institute of Mental Health found that patients with severe mental illness who used a clinical decision support system for cardiovascular (CV) risk and treatment options showed lower rates of CV risk.

The study, published in JAMA Network, was led by Rebecca Rossom, MD, a senior research investigator at HealthPartners Institute in Minneapolis. CV disease is the leading cause of death among those with serious mental illness (SMI), who also have shortened lifespans compare to those without SMI. Rossom and her colleagues set out to discover whether a clinical decision support system influences the CV health of those with SMI which includes schizophrenia, schizoaffective disorder, and bipolar disorder.

The study observed 8,937 adults aged 18 to 75 with SMI from 76 different primary care clinics in Minnesota, North Dakota, and Wisconsin. Each patient had at least one cardiovascular risk factor in an unhealthy goal range. Clinics were randomly assigned different interventions. At 42 clinics, healthcare workers were asked to fill out decision-making handouts with their patients that provided individualized information about the patient’s cardiovascular health and treatment options. The other 34 clinics did not use a clinical decision support system.

In a 12 month follow-up, patients who received clinical decision support had a total modifiable cardiovascular risk that was four percent lower than the control group.

“While the difference in modifiable cardiovascular risk due to the intervention may seem small at four percent, it is clinically significant and translates to potentially preventing three heart attacks or strokes for every 1,000 patients with SMI,” Rossom said in a statement.

According to researchers, there was not a particular modifiable risk factor that led to the overall four percent reduction in cardiovascular risk. Instead, the reduced risk was due to a combination of changes across all risk factors which included smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, and hemoglobin A1c level.

These findings indicate that clinical decision support may help improve cardiovascular health outcomes in those with SMI, highlighting the importance of early, personalized intervention.