Cardiometabolic health state and related management of indigenous and non-indigenous Australians receiving clozapine – A retrospective cross-sectional observational study

Abstract

Objective

Clozapine is effective, but is associated with cardiometabolic disease burden. The cardiometabolic health of Indigenous Australians taking clozapine is unclear. This study aimed to determine the cardiometabolic health state and management of Indigenous and non-Indigenous clozapine patients over 1 year.

Methods

A retrospective cross-sectional observational study using clinical data from a regional clozapine clinic. We calculated QRisk3 cardiovascular disease (CVD) risk scores and the prevalence of diabetes, hypertension and metabolic syndrome (MES). Cardiometabolic monitoring and management were also analysed. Findings were compared between Indigenous and non-Indigenous patients.

Results

Overall, 76 patients were included (35.5% Indigenous). Ninety-seven percent had complete metabolic monitoring data for MES. Prevalences of diabetes (22.3%), hypertension (42.1%), and MES (68.4%) were high. Indigenous patients had significantly higher levels of diabetes, CVD risk and reduced high-density lipoprotein (HDL). The majority (84.2%) of patients received lifestyle advice. Follow-up with allied health services and communication with general practicioners (GPs) was limited. Indigenous patients were significantly more likely to receive pharmacological treatments.

Conclusions

A high cardiometabolic disease burden was observed, which was significantly greater in Indigenous patients. All received excellent cardiometabolic monitoring, but lifestyle interventions were underutilised. Clear treatment guidelines and better integration of monitoring and management are required.