professor julia hippisley-cox university of nottingham
TRANSCRIPT
![Page 1: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/1.jpg)
Cardiovascular risk in high secure environments
Professor Julia Hippisley-CoxUniversity of Nottingham
![Page 2: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/2.jpg)
West London Mental Health Trust Clinical staff at three hospitals R&D and MREC EMIS TPP Vision QResearch
Acknowldegments
![Page 3: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/3.jpg)
Compare CVD risk factor recording and CVD risk in SEMI patients in each of the 3 hospitals with SEMI patients in QResearch
Objectives
![Page 4: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/4.jpg)
NICE PH15 - identify & reduce risk premature mortality
NICE CG68 - identify & reduce CVD risk DRC enquiry -poor physical health of
patients with SEMI
Background
![Page 5: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/5.jpg)
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
Key findings DRC report:
![Page 6: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/6.jpg)
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
NICE guidelines (2008, CG67)
![Page 7: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/7.jpg)
Comparison of CVD Risk in four groups with SEMI1. Broadmoor hospital - EMIS2. Rampton hospital3. Ashworth hospital4. QResearch – community sample
R&D and MREC approval Extraction of pseudoymised patient level
data
New study 2012
![Page 8: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/8.jpg)
Age Chronic renal disease
Sex Diabetes
Ethnicity Hypertension
Smoking status CHD/stroke
Body mass index Medication but not recorded systematically in any of the hospitals
Lipids
Systolic blood pressure
Rheumatoid arthritis
Data items collected
![Page 10: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/10.jpg)
Recording of family historylower in hospital
Hospital A 9% Hospital B 3%Hospital C 4%QResearch 14%
![Page 11: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/11.jpg)
Variation in recording of ethnicity
Large variation
Hospital A 48% Hospital B 0%Hospital C 97%QResearch 84%
![Page 12: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/12.jpg)
Recording of body mass index
Generally higher and more recent in hospital patients
![Page 13: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/13.jpg)
Obesity levels very highOver half all hospital patients obese c.f. 29% in QResearch
![Page 14: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/14.jpg)
Type 2 Diabetes also very high
One in 5 hospital patients have diabetesTwice as high as community5 times as high as non-SEMI
![Page 15: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/15.jpg)
Diabetes by ageMarked risk with increasing age – 29% patients over 50 have diabetes
![Page 16: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/16.jpg)
Fasting blood glucose testingHuge variation in FBS testing but doesn’t explain high prevalence of diabetes in all hospital settings
![Page 17: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/17.jpg)
SBP control < 150/90Overall most patients meeting BP targets
![Page 18: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/18.jpg)
Cholesterol < 5 mmol/lOverall many patients meeting cholesterol targetsBetter than QResearch
![Page 19: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/19.jpg)
Recording 7 QOF SEMI register
Patients with QOF code for SEMI have higher risk factor recording ratese.g. 87% with QOF code have glucose recorded cf 37% without QOF code
![Page 20: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/20.jpg)
QResearch no SEMI
QResearch SEMI
HospitalSEMI
<10% risk 91.2 83.8 83.5
10-19.9% risk
7.1 12.2 12.0
20%+ risk 1.7 4.0 4.6
CVD risk resultsHospital patients more than twice as likely to have high CVD risk compared with community patients
![Page 21: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/21.jpg)
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
Summary: hospital vs community
![Page 22: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/22.jpg)
Recommendation 1: urgent need to commission services for
weight loss including diet, exercise & medication review
Recomendation 2: Interventions to lower diabetes riskRecommendation 3: Use of QOF SEMI codes to identify patients
and make use of computer QOF audit facilities
Summary recommendations
![Page 23: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/23.jpg)
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
Recommendation4
![Page 24: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/24.jpg)
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
Recommendations 5-8
![Page 25: Professor Julia Hippisley-Cox University of Nottingham](https://reader030.vdocument.in/reader030/viewer/2022032706/56649dde5503460f94ad7774/html5/thumbnails/25.jpg)
Report published at www.qresearch.org Any questions
Thank you for listening