People with psychosis should have electrocardiograms (ECGs) to monitor their heart’s rhythm and electrical activity when they are admitted to hospital, according to NICE (The National Institute for Health and Care Excellence) guidelines. This is because anti-psychotic medications influence the electrical conductivity of the heart, particularly when the patient is taking higher doses which can lead to a greater risk of sudden death.
However, in practice, there is a variation in recommendations regarding giving routine ECGs to people with psychosis, ranging from offering an ECG if people have risk factors such as high blood pressure or a family history of cardiovascular disease, to giving annual ECGs according to South London and Maudsley’s Prescribing Guidelines. Another issue is that in mental health settings, psychiatrists often have limited experience in interpreting ECGs.
CLAHRC South London has adopted a project led by Dr Fiona Gaughran, a reader at King’s College London and consultant psychiatrist, who is working with King’s College Hospital’s cardiology department. This pilot project will link the hospital’s ECG system directly to selected wards at South London and Maudsley NHS Foundation Trust. The results will be interpreted by experts in the hospital’s cardiology department. This will allow the researchers to test how effective clinical practice currently is and to develop a new standard for carrying out ECGs in people with psychosis. The team will also carry out a literature review of studies in this field to analyse the evidence on routine ECGs in community patients and make recommendations for best practice.
‘Dr Gaughran says: ‘We need to establish better systems and methods for interpretation of ECGs in mental health trusts. This collaborative project will provide a base to develop evidence-based best practice in clinical ECG interpretation. We also hope this work will lead to further research in this area to address a major health inequality for people with mental health problems.’’
This project was adopted by CLAHRC South London in May 2016. This pilot study is funded by NIHR Maudsley BRC.