Can a co-produced, assertive care intervention reduce cardiovascular disease risk in people living with severe mental illness in the primary care setting? The Assertive Cardiac Care Trial

Problem

An established evidence base shows that people with severe mental illnesses have higher risk for cardiovascular disease (CVD) which contributes to an established 10-20 year mortality gap when compared with the public. Current research indicates that many of the factors for increased CVD risk in people living with severe mental illness are modifiable such as diet, exercise, reductions in blood pressure, high cholesterol, smoking and alcohol use. To address current unmet needs in this population, we co-produced an intervention using assertive community treatment and motivational interviewing principles combined with dedicated nurse and general practitioner care over 12 months to be tested in the primary care setting.

Approach

Addressing CVD risk calls for a focus on multiple rather than single risk factors, and to deliver targeted CVD risk assessment combined with tailored pharmacological and non-pharmacological interventions with proactive follow-up, monitoring and treatment intensification as required. Assertive Cardiac Care delivers this with trained nurses facilitating guided conversations to identify goals, provide regular face to face, phone and technology-mediated support over 12 months. General practitioners are engaged in care planning, medication and reviews. Five hundred and fifty eligible adults aged 35-75 years old, with a diagnosis of schizophrenia, psychosis, delusional disorder, bipolar disorder, or major depression will be recruited from Australian primary care settings. Eligible participants will be invited to a nurse facilitated Healthy Heart check to determine the 5-year absolute cardiovascular disease risk, then they will be individually randomised to the intervention or an active control group (n=252 per group). The active control will receive heart health information, and a referral to their general practitioner to follow up.

Findings

The primary outcome is 2% difference between intervention and active control in mean 5-year risk for cardiovascular disease using the Australian Absolute Risk Calculator. Assessments will be conducted at baseline, six months and twelve months. Secondary outcome measures include individual cardiovascular risk factors, patient activation, empowerment, quality of life, medication adherence and health economics at 6 and 12 months.

Consequences

There is growing consensus that co-produced interventions may have more potential to reach and engage people living with severe mental illness, but we need an evidence base to inform decision making in these areas. Findings cost-effective ways to address the high CVD risk in this group is essential. If this intervention can reduced CVD risk it will be suitable for wider implementation in the primary care setting.