Cardiovascular risk management for patients with a severe mental illness

This thesis explores the management of cardiovascular risk (CVR) in primary healthcare for patients with a severe mental illness (SMI) from the perspective of general practitioners (GPs) and develops an intervention to reduce CVR. Given that individuals with an SMI have a significantly reduced life expectancy due to heightened CVR, the study examines the role of GPs in mitigating these risks and the challenges they face.
Findings indicate that CVR screening for SMI patients in Dutch primary care is inadequate, with only 8.5% of patients being screened in the absence of diabetes or cardiovascular disease. GPs express a sense of responsibility but lack awareness, confidence, and adequate collaboration with psychiatrists. To address these issues, the ‘Transmural collaborative care model for CVRM and medication review in patients using AntipsyChoTICs’ (TACTIC) was developed. This multidisciplinary intervention demonstrated promising feasibility, improving CVR outcomes in initial testing. However, challenges such as patient inclusion and adherence remain.
The thesis recommends improving interdisciplinary collaboration, standardizing CVRM in guidelines, and incorporating lived experience perspectives. If proven effective in the upcoming trial, TACTIC could serve as a scalable, evidence-based model for integrating CVRM into primary care and reducing CVR-related mortality in SMI patients.