Cardiometabolic health reviews in patients on antipsychotics: The impact of Covid-19

ABSTRACT

Background: Antipsychotics are associated with metabolic disturbances adversely affecting cardiometabolic health. Routine cardiometabolic monitoring is subsequently an important component of care in patients on antipsychotics. During the Covid-19 pandemic, there has been a transition towards remote consulting. Understanding the effect of the pandemic on routine primary care activity may help avoid potential adverse health outcomes. Research question This study aimed to identify the local impact of the Covid-19 pandemic on cardiometabolic monitoring in patients on antipsychotics. Methods: A cross-sectional analysis was performed of patients on antipsychotic medications at a suburban South-West London practice. Patients were identified through a search via EMIS Web. Inclusion criteria included those registered permanently and commenced on medication prior to 17 December 2018. Primary outcomes included the difference in the yearly incidence of recorded weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c and lipids. Statistical significance was defined by p<0.050. Results: Fifty-three patients met the inclusion criteria. The mean patient age was 52.2 (±17.4). A total of 64 antipsychotics were on repeat prescriptions, with quetiapine (N=18;28.1%) and olanzapine (n=18;28.1%) being the most commonly prescribed. Comparing 2019 against 2020, there was no statistically significant difference in incidence of recorded weight (2019 49.2%;2020 49.2%;p=0.698), waist circumference (2019 10.2%;2020 6.8%;p=0.486), pulse (2019 20.3%;2020 11.9%;p=0.672), blood pressure (2019 59.3%;2020 44.1%;p=0.821), fasting blood glucose (2019 5.1%;2020 0.0%;p=1.000), HbA1c (2019 72.9%;2020 49.2%;p=0.613), lipids (2019 55.9%;2020 39.0%;p=0.251). Conclusion: A reduction in cardiometabolic monitoring was observed in this studied population locally in 2020. This was not statistically significant but may be clinically significant for longterm health outcomes on an individual patient basis. It is important that any potential adverse effects on different populations of increased remote consulting during and beyond the Covid-19 pandemic are identified. Health systems may be reconfigured to ensure robust follow-up and reduce excess mortality.