Professor Julia Hippisley-Cox
University of Nottingham
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West London Mental Health Trust
Clinical staff at three hospitals
R&D and MREC
EMIS
TPP
Vision
QResearch
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Compare CVD risk factor recording and CVD
risk in SEMI patients in each of the 3 hospitals
with SEMI patients in QResearch
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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
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Less
Less
Less
Less
likely
likely
likely
likely
to
to
to
to
be offered interventions
report symptoms
take prescribed medicines
reach targets for lipids
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Lipid modification guidelines
Identify patients at increased CVD risk
Quantify increased risk using QRISK2 or
similar
Modify risk factors
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weight loss
Blood pressure control
Lipid control
Smoking cessation
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Comparison of CVD Risk in four groups with
SEMI
1.
2.
3.
4.
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Broadmoor hospital - EMIS
Rampton hospital
Ashworth hospital
QResearch – community sample
R&D and MREC approval
Extraction of pseudoymised patient level data
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
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
Hospital patients more than twice as likely to
have high CVD risk compared with community
patients
QResearch
no SEMI
QResearch
SEMI
Hospital
SEMI
91.2
83.8
83.5
10-19.9% risk
7.1
12.2
12.0
20%+ risk
1.7
4.0
4.6
<10% risk
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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
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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
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Report published at www.qresearch.org
Any questions