Cardiometabolic screening and mortality reduction — Rapid

Synopsis

Turn physical-health screening in severe mental illness into practical prevention, recognise cardiometabolic disease without diagnostic overshadowing, and assign follow-up actions that reduce avoidable illness and premature death.

The core annual severe-mental-illness check covers alcohol use, smoking, BMI, blood pressure, glucose or HbA1c and lipids.
A completed measurement is useful only when abnormal results are explained, acted on and followed through.
Antipsychotic initiation requires additional early monitoring; an annual review does not replace the first-six-week and twelve-week schedule.
Use QRISK3 when estimating cardiovascular risk in severe mental illness or with atypical antipsychotic treatment because older tools omit these factors.
Offer atorvastatin 20 mg daily for primary prevention at a ten-year QRISK3 of at least 10%, after an informed discussion and appropriate baseline assessment.
A lower calculated risk does not automatically exclude a statin when risk may be underestimated or the person has an informed preference.
Offer tailored help with smoking, diet, activity, alcohol and access to care, alongside standard treatment for hypertension, diabetes and dyslipidaemia.
Review cancer screening, vaccination, oral health and respiratory symptoms as well as cardiovascular measurements.

Key red flags

Thirst, polyuria, vomiting, dehydration or drowsiness during antipsychotic treatment warrants immediate glucose assessment and ketones where clinically indicated.

Exertional chest pain, syncope, new focal weakness or acute breathlessness requires the same urgent investigation as in someone without severe mental illness.

Repeated missed preventive appointments may indicate transport, cognitive, financial or service-access barriers that need active resolution.

Investigation priorities

Core annual health measurementsFirst step

Assess the principal modifiable cardiometabolic and substance-use risks.

Management branches

EngagementMake the health check accessible

A person with severe mental illness is due a preventive review or has missed previous appointments.

Agree a familiar location, suitable appointment length, reminders and support with transport or blood-test anxiety.
Complete the core assessment and ask about additional symptoms and preventive care that matter to the person.
Give an understandable written or accessible action plan and confirm how results and next steps will be communicated.

Key medicines

Atorvastatin for primary cardiovascular preventionOffer atorvastatin 20 mg orally once daily when ten-year QRISK3 is 10% or more, following shared decision-making; continue long term while benefit and tolerability remain favourable.Check pregnancy potential, active liver disease, interactions and baseline transaminases; investigate unexplained muscle symptoms and use the appropriate separate pathway for established cardiovascular disease.

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