Abstract P339: Cardiovascular Preventive Care In Patients Using Psychotropes: Impact On Primary Care

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Background Patients on psychotropic medications are at higher cardiometabolic risk compared to the general population because of obesity, diabetes, hypertension and hyperlipidemia making primary prevention important. We sought to assess preventative strategies in primary care setting for this population. Methods We conducted a cross sectional analysis using the limited access dataset of National Ambulatory Medical Care Survey from year 2000-2009. Patients between 18-85 years who visited primary care clinics were included. Demographics including age, gender, race, region and type of insurance were analyzed. Psychotropes included in our analysis were typical and atypical anti- psychotics, selective serotonin reuptake inhibitors, serotonin - norepinephrine reuptake inhibitors, norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and tricyclic antidepressants. Multivariate logistic regression model was used to compute the adjusted odds ratio to compare the health conditions and its preventative care with and without psychotrope use. Results There were a total of 279,819 patient visits. Psychotropic medication use was documented in 6% of visits. The use of psychotropes was higher among middle age persons (45%), women (67%) and Southern regions(35%). Obesity (41% Vs 29% P = 0.02), hyperlipidemia (18.5% Vs 15.2% P = <0.0001) and smoking (17% Vs 10% P = <0.0001) were reported more often in visits for patients with psychotropes use compared to patients without psychotrope use. There was no difference in the prevalence of hypertension (P = 0.1) or diabetes (P= 0.3). Patients on psychotropes had a higher rate of aspirin use(8% Vs 3%), statin use(48% Vs 36%), antihypertensive use (69% Vs 48%) and stress-management counseling (28% Vs 5%) but a proportionally similar rate of smoking cessation advice (25% Vs 19%) compared to those not on psychotropes. Despite a higher prevalence of obesity and hyperlipidemia, adequate preventive counseling was not provided to patients on psychotropes for diet /nutrition (10.8 Vs 10.4 P = 0.5), exercise (10.1 Vs 8.7 P = 0.8) and weight reduction (9 Vs 6.6 P = 0.1 Conclusion In this large cohort,patients on psychotropes were found to be at increased cardiovascular risk and were treated aggressively with medications. Yet, this at-risk population received lesser degree of counseling for lifestyle modification. It is important for primary care physicians who see nearly one third of this high risk population, to understand this association and focus on preventive and lifestyle counseling.