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Heart risk underestimated in patients with mental illness

Heart disease is a major killer for people with mental illness and one Wellington doctor is trying to turn this around.

Dr Ruth Cunningham, of the University of Otago in Wellington, has just released findings of her two-year study, looking into how care for patients with severe mental illness can be improved.

The Heart Foundation funded study, shows the risk of cardiovascular disease in patients with mental illness is underestimated by 60 per cent among women and 30 per cent among men. Meaning people with a high risk of heart disease aren’t being identified as needing care and this is likely to be contributing to the high death rates from cardiovascular disease among people with mental illness.

Research shows people with mental illness die up to 20 years earlier, with heart disease being the mental health sector’s third biggest killer after suicide and cancer.

“We should be assessing the risk of these patients a lot earlier. We’re just not managing the underlying risk in this group,” says Dr Cunningham.

Approximately six per cent of adults being assessed by their GP for cardiovascular disease will have had recent contact with a mental health service.

Dr Cunningham says General Practitioners need to be taking mental health into consideration when assessing cardiovascular disease risk, realising that a higher index of suspicion will be required. Further work is needed to change the tools GPs use to calculate the risk in order to address the high rates of death from heart disease among people with mental illness, and Dr Cunningham hopes to complete this work soon.

Caro Swanson is the Principal Advisor of Mental Health at Te Pou o te Whakaaro Nui and has worked in the mental health sector for 20 years. She has bipolar disorder and at the age of 58 suffered a massive heart attack and was rushed in for a quadruple bypass a week later.

Caro says she had all the markers of heart disease but it was never diagnosed because doctors focus on her mental illness and miss screening for other physical conditions.

“The astonishing thing was I had all the markers of heart disease. They should have known I was at high-risk. But it wasn’t picked up by the mental health service or my GP. It was this huge gap in care,” she says.

The 2018 revision of the CVD risk management guidance, published by the Ministry of Health for the first time, recognised the association between serious mental illness which was highlighted in New Zealand by Dr Cunningham’s work. The new guidelines recommend heart and stroke risk assessment start at 20 years of age for these patients.

Dr Cunningham’s research has been published in the journal PLOS ONE and the findings were presented at the Royal Australasian College of Psychiatry New Zealand meeting in Nelson yesterday (18 September).

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