Assessing cardiometabolic parameter monitoring in inpatients taking a second-generation antipsychotic : the CAMI-SGA study – a crosssectional study
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BMJ Open
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BMJ Publishing Group
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Objectives This study aims to determine the proportion
of initial cardiometabolic assessment and its predicting
factors in adults with schizophrenia, bipolar disorder or
other related diagnoses for whom a second-generation
antipsychotic was prescribed in the hospital setting.
Design Cross-sectional study.
Setting The psychiatry unit of a Canadian tertiary care
teaching hospital in Montreal, Canada.
Participants 402 patients with aforementioned
disorders who initiated, restarted or switched to one
of the following antipsychotics: clozapine, olanzapine,
risperidone, paliperidone or quetiapine, between 2013
and 2016.
Primary outcome measures We assessed the proportion
of cardiometabolic parameters monitored.
Secondary outcome measures We identified predictors
that influence the monitoring of cardiometabolic
parameters and we assessed the proportion of adequate
interventions following the screening of uncontrolled blood
pressure and fasting glucose or glycated haemoglobin
(HbA1c) results.
Results Only 37.3% of patients received monitoring
for at least three cardiometabolic parameters. Blood
pressure was assessed in 99.8% of patients; lipid profile
in 24.4%; fasting glucose or HbA1c in 33.3% and weight
or body mass index in 97.8% of patients while waist
circumference was assessed in 4.5% of patients. For
patients with abnormal blood pressure and glycaemic
values, 42.3% and 41.2% subsequent interventions were
done, respectively. The study highlighted the psychiatric
diagnosis (substance induced disorder OR 0.06 95% CI
0.00 to 0.44), the presence of a court-ordered treatment
(OR 0.79 95% CI 0.35 to 1.79) and the treating psychiatrist
(up to OR 34.0 95% CI 16.2 to 140.7) as predictors of
cardiometabolic monitoring.
Conclusions This study reports suboptimal baseline
cardiometabolic monitoring of patients taking an
antipsychotic in a Canadian hospital. Optimising
collaboration within a multidisciplinary team may increase
cardiometabolic monitoring.
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