Implementation of a 10-year Cardiovascular Disease Risk Registry on an Integrated Assertive Community Treatment Team

Abstract

Patients with severe mental illness (SMI) are at higher risk for cardiovascular disease (CVD) than the general population due to medication side effects, social determinants of health, and SMI symptoms, yet screening for cardiometabolic disease in people with SMI remains low. Current evidence-based guidelines call for use of the pooled cohort equation (PCE) 10-year atherosclerotic cardiovascular disease (ASCVD) risk score to guide prevention and CVD risk management. The project site lacked an available PCE 10-year ASCVD calculator in its electronic health record, therefore 10-year ASCVD risk screening rates were low and cardiometabolic disease prevention not concordant with current guidelines. A systematic literature review found registries are effective tools to track CVD risk factors and can help to increase prevention interventions and improve risk factors in the SMI population. The purpose of this Doctor of Nursing Practice project was to increase ASCVD risk screening for patients with SMI and use the screening tool to increase prevention interventions. A risk score registry was used to increase CVD self-management support (SMS) for high-risk patients assigned to an integrated assertive community treatment (ACT) team. Increase in risk score calculation and SMS interventions were determined by comparing the three-month implementation period to a comparison period three months prior. Results indicated that risk scores were calculated for 88.9% of eligible patients after implementation, 18.6% of whom were high-risk. Within the high-risk cohort, there was an 88.4% increase in SMS interventions. Seven of nine high risk patients (77.8%) had an increase in SMS interventions with a median increase of six interventions (95% CI:0-14; p=0.02). This project found that implementing a 10-year ASCVD risk score registry within an integrated ACT team resulted in a significant increase in CVD-related self-management support interventions for high-risk patients.