Understanding and Preventing Cardiovascular diseases in people taking AntiPsychotic medications: a data-driven mixed methods study (PreCAP)

Background People taking antipsychotics face a 2-4-fold higher risk of cardiac mortality and sudden cardiac death respectively compared to those without antipsychotic exposure.

Prescription of antipsychotics has increased to 12.6 million, however cardiovascular disease (CVD) risk management is inadequately implemented, and interventions are not effectively modified for all those prescribed antipsychotics.

Physical examinations only occurred in Aim and objectives To establish evidence and recommendations for better prediction and prevention of CVD for people prescribed antipsychotics to reduce inequality and morbidity.

O1) Examine effectiveness of existing models of care, interventions and services in reducing CVD risks for people prescribed antipsychotics; O2) Identify variation in CVD risk for individual antipsychotics and deficiencies in CVD risk management; O3) Understand the experience of CVD care and factors related to access to and receipt of high-quality health care; O4) Establish consensus on recommendations to prevent CVD for people taking antipsychotics.

Methods A mixed methods approach comprising four work packages (WP): a systematic review, a matched cohort study of routine data, interviews, and a Delphi study.

WP1(O1): a systematic review and meta-analysis estimating the effects of reported care models/interventions/services on CVD risk management and outcomes. Evidence will be synthesised as 'Do', 'Don't' and 'Don't know' according to effectiveness reported. WP2(O2): a matched cohort study of routinely-collected anonymised patient data across the UK.

This WP will model differential CVD risk across antipsychotics and deficiencies in CVD prevention, compared with those with no exposure to antipsychotics or SMI.

WP3(O3): semi-structured interviews with people taking antipsychotics and clinicians in primary and secondary health services.

The interviews will capture experiences of accessing CVD and physical health care, including factors relating to delivery of high-quality service. WP4(O4): a synthesis of findings from WP1-3 to inform a Delphi consensus with patients, clinicians and commissioners.

The WP will establish a consensus on recommendations for best practices for effective care to prevent CVD for people prescribed antipsychotics.

Impact and dissemination NHS/Patient impact: through Mental Health Research for Innovation Centre (M-RIC), evidence-based recommendations for reducing risk of CVD will ultimately improve CVD risk management and reduce inequalities in clinical services/pathways to improve patient outcomes.

Career impact: support my transition to being a prominent research leader advancing mental health inequalities and enhancing capacity building.

Dissemination strategy: through a multi-modal, multi-language dissemination plan, I will tailor communications to those taking antipsychotics, caregivers and supporting communities; health care providers/integrated care boards; GPs and mental health researchers and national/international policymakers.

I will share outputs through peer-reviewed publications, relevant policy and translational health networks.