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The Resource Interventions to improve cardiovascular risk factors in people with serious mental illness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center; investigators, Jennifer M. Gierisch, Ph.D., M.P.H., Jason A Nieuwsma, Ph.D., Daniel W. Bradford, M.D., M.P.H., Christine M. Wilder, M.D., Monica C. Mann-Wrobel, Ph.D., Amanda J. McBroom, Ph.D., Liz Wing, M.A., Michael D. Musty, B.A., Megan M. Chobot, M.S.L.S., Vic Hasselblad, Ph.D., and John W. Williams, Jr., M.D., M.H.Sc

Interventions to improve cardiovascular risk factors in people with serious mental illness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center; investigators, Jennifer M. Gierisch, Ph.D., M.P.H., Jason A Nieuwsma, Ph.D., Daniel W. Bradford, M.D., M.P.H., Christine M. Wilder, M.D., Monica C. Mann-Wrobel, Ph.D., Amanda J. McBroom, Ph.D., Liz Wing, M.A., Michael D. Musty, B.A., Megan M. Chobot, M.S.L.S., Vic Hasselblad, Ph.D., and John W. Williams, Jr., M.D., M.H.Sc

Creator
Author
Contributor
Summary
OBJECTIVES: Individuals with serious mental illness (SMI) have excess mortality from cardiovascular disease (CVD) and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. We conducted a systematic review to evaluate interventions to improve CVD risk factors in adults with SMI. DATA SOURCES: We searched PubMed(r), Embase(r), PsycINFO(r), and the Cochrane Database of Systematic Reviews for English-language trials published since 1980 that evaluated patient-focused behavioral interventions, peer or family support interventions, pharmacological treatments, and multicondition lifestyle interventions, or their combination, that targeted weight control, glucose levels, lipid levels, or CVD risk profile among adults with SMI at elevated risk of CVD. REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion, abstracted data, and performed quality ratings, efficacy-effectiveness ratings, and evidence grading. Qualitative and quantitative methods, using random-effects models, were used to summarize results. RESULTS: Of 35 eligible studies, most enrolled patients with schizophrenia who were prescribed antipsychotics. Most studies were designed to control weight (n=28); one study specifically addressed diabetes management, none targeted hyperlipidemia, and three were multicondition interventions. Most studies were efficacy trials comparing behavioral interventions with control; none evaluated peer and family support. There were few direct comparisons of active interventions; effects on overall CVD risk, physical functioning, or cardiovascular events were reported rarely. Compared with controls, behavioral interventions (mean difference [MD] 3.13 kg; 95% CI, 4.21 to 2.05), metformin (MD 4.13 kg; CI, 6.58 to 1.68), the anticonvulsive medications topiramate and zonisamide (MD 5.11kg; CI, 9.48 to 0.74), and adjunctive or antipsychotic switching to aripiprazole improved weight control. However, aripiprazole switching may be associated with higher rates of treatment failure. Nizatidine did not improve any outcome. The evidence was insufficient for all other interventions and effects on glucose and lipid control. CONCLUSIONS: Few studies have evaluated interventions to address one or more CVD risk factors in patients with SMI. Comparative effectiveness studies are needed to test multimodal strategies, agents known to be effective in non-SMI populations, and antipsychotic-management strategies
Language
eng
Work
Publication
Extent
1 online resource (176 pages)
Note
"April 2013."
Instance
Label
Interventions to improve cardiovascular risk factors in people with serious mental illness
Title
Interventions to improve cardiovascular risk factors in people with serious mental illness
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center; investigators, Jennifer M. Gierisch, Ph.D., M.P.H., Jason A Nieuwsma, Ph.D., Daniel W. Bradford, M.D., M.P.H., Christine M. Wilder, M.D., Monica C. Mann-Wrobel, Ph.D., Amanda J. McBroom, Ph.D., Liz Wing, M.A., Michael D. Musty, B.A., Megan M. Chobot, M.S.L.S., Vic Hasselblad, Ph.D., and John W. Williams, Jr., M.D., M.H.Sc
Title variation
Effective health care program
Creator
Contributor
Author
Issuing body
Subject
Genre
Language
eng
Summary
OBJECTIVES: Individuals with serious mental illness (SMI) have excess mortality from cardiovascular disease (CVD) and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. We conducted a systematic review to evaluate interventions to improve CVD risk factors in adults with SMI. DATA SOURCES: We searched PubMed(r), Embase(r), PsycINFO(r), and the Cochrane Database of Systematic Reviews for English-language trials published since 1980 that evaluated patient-focused behavioral interventions, peer or family support interventions, pharmacological treatments, and multicondition lifestyle interventions, or their combination, that targeted weight control, glucose levels, lipid levels, or CVD risk profile among adults with SMI at elevated risk of CVD. REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion, abstracted data, and performed quality ratings, efficacy-effectiveness ratings, and evidence grading. Qualitative and quantitative methods, using random-effects models, were used to summarize results. RESULTS: Of 35 eligible studies, most enrolled patients with schizophrenia who were prescribed antipsychotics. Most studies were designed to control weight (n=28); one study specifically addressed diabetes management, none targeted hyperlipidemia, and three were multicondition interventions. Most studies were efficacy trials comparing behavioral interventions with control; none evaluated peer and family support. There were few direct comparisons of active interventions; effects on overall CVD risk, physical functioning, or cardiovascular events were reported rarely. Compared with controls, behavioral interventions (mean difference [MD] 3.13 kg; 95% CI, 4.21 to 2.05), metformin (MD 4.13 kg; CI, 6.58 to 1.68), the anticonvulsive medications topiramate and zonisamide (MD 5.11kg; CI, 9.48 to 0.74), and adjunctive or antipsychotic switching to aripiprazole improved weight control. However, aripiprazole switching may be associated with higher rates of treatment failure. Nizatidine did not improve any outcome. The evidence was insufficient for all other interventions and effects on glucose and lipid control. CONCLUSIONS: Few studies have evaluated interventions to address one or more CVD risk factors in patients with SMI. Comparative effectiveness studies are needed to test multimodal strategies, agents known to be effective in non-SMI populations, and antipsychotic-management strategies
Member of
Cataloging source
NLM
http://library.link/vocab/creatorName
Gierisch, Jennifer M
Funding information
Conducted by the Duke Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ)
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WG 120
http://library.link/vocab/relatedWorkOrContributorName
  • Nieuwsma, Jason A.
  • Bradford, Daniel W.
  • Wilder, Christine M.
  • Mann-Wrobel, Monica C.
  • McBroom, Amanda J.
  • Wing, Liz
  • Musty, Michael D.
  • Chobot, Megan M.
  • Hasselblad, Victor
  • Williams, John W.
  • United States
  • Duke University Evidence-based Practice Center
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness reviews
  • AHRQ publication
Series volume
  • number 105
  • no. 13-EHC063-EF
http://library.link/vocab/subjectName
  • Cardiovascular Diseases
  • Comparative Effectiveness Research
  • Mentally Ill Persons
  • Risk Factors
http://bibfra.me/vocab/relation/supportingbody
  • SGEpYsXqBGk
  • RzTDSdffmEM
Label
Interventions to improve cardiovascular risk factors in people with serious mental illness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center; investigators, Jennifer M. Gierisch, Ph.D., M.P.H., Jason A Nieuwsma, Ph.D., Daniel W. Bradford, M.D., M.P.H., Christine M. Wilder, M.D., Monica C. Mann-Wrobel, Ph.D., Amanda J. McBroom, Ph.D., Liz Wing, M.A., Michael D. Musty, B.A., Megan M. Chobot, M.S.L.S., Vic Hasselblad, Ph.D., and John W. Williams, Jr., M.D., M.H.Sc
Instantiates
Publication
Note
"April 2013."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier.
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent.
Control code
851693452
Extent
1 online resource (176 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia.
Media type code
  • c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)851693452
Label
Interventions to improve cardiovascular risk factors in people with serious mental illness, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center; investigators, Jennifer M. Gierisch, Ph.D., M.P.H., Jason A Nieuwsma, Ph.D., Daniel W. Bradford, M.D., M.P.H., Christine M. Wilder, M.D., Monica C. Mann-Wrobel, Ph.D., Amanda J. McBroom, Ph.D., Liz Wing, M.A., Michael D. Musty, B.A., Megan M. Chobot, M.S.L.S., Vic Hasselblad, Ph.D., and John W. Williams, Jr., M.D., M.H.Sc
Publication
Note
"April 2013."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier.
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent.
Control code
851693452
Extent
1 online resource (176 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia.
Media type code
  • c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)851693452

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