Cross-disciplinary cardiovascular and psychiatric recommendations: A systematic review of clinical guidelines

Abstract

Introduction

Individuals with serious mental illness (SMI), including major depression, schizophrenia, and bipolar disorder, experience disproportionately high rates of cardiovascular (CV) risk and disease. Despite this well-established connection, it remains unclear how professional society guidelines across cardiology and psychiatry address this relationship.

Methods

Major American and European CV and psychiatric society guidelines published from 2013-2023 were reviewed. Included were guidelines on primary and secondary CV disease prevention, and disease-specific guidelines for schizophrenia, bipolar disorder, and major depressive disorder. Relevant text was extracted and classified as recommendations or supporting text.

Results

Twenty-six guidelines were included (13 CV; 13 psychiatric). Psychiatric considerations appeared in 5 CV guidelines (38%), most commonly addressing mental illness treatment to improve CV outcomes (n = 5), pharmacological considerations (n = 2), and recognition of mental illness as a CV risk factor (n = 2). Only 13% of American CV guidelines included psychiatric content, compared to 80% of European CV guidelines. In contrast, 10 psychiatric guidelines (77%) included CV-related recommendations, including CV screening (n = 16), pharmacological considerations (n = 8), and risk factor control (n = 7). Among psychiatric guidelines, 40% of U.S. and 100% of European documents included CV content.

Conclusions

CV considerations are more frequently addressed in psychiatric than psychiatric considerations in CV guidelines. European guidelines showed greater cross-disciplinary integration. These findings highlight the need for more unified, interdisciplinary guidance to reduce CV risk in individuals with SMI.