# Implementation of the healthy heart tool- an algorithm with potential cardiometabolic health benefits in persons with severe mental illness

## TL;DR

A tool called the Healthy Heart Tool was implemented to improve heart health in people with severe mental illness, showing some success in increasing dietary advice and reducing high cholesterol.

## Contribution

The study evaluates the real-world effectiveness of the Healthy Heart Tool in improving cardiometabolic risk management for individuals with severe mental illness.

## Key findings

- More patients received dietary and salt reduction advice after implementing the Healthy Heart Tool.
- There was a significant decrease in the number of patients with high cholesterol levels.

## Abstract

Cardiometabolic diseases are the main causes of death in persons with severe mental illness (SMI), highlighting the need to improve management of cardiovascular risk factors in both primary and specialized health care. The “Healthy Heart Tool” aims at helping health care workers to identify persons at risk, and to initiate proper interventions. Here we investigate if the recommendations in the Healthy Heart Tool are followed one year after implementation and whether implementation of the tool improved cardiometabolic risk factors in SMI.

Data from 270 individuals with SMI from six Norwegian hospitals were collected at baseline and at 12 months after implementation of the Healthy Heart Tool throughout the health care services. Changes from baseline to 12 months follow-up were analyzed using chi-square and independent t-tests, whereas implementation effects were analyzed using logistic general linear mixed models.

After implementing the Healthy Heart Tool, significantly more persons received dietary advice and/or salt restriction advice (75.5% vs. 84.8%, p = 0.035). After controlling for Body Mass Index (BMI) ≥ 30 and sex, there was an odds ratio (OR) of 8.9 (95% CI 1.42–55.77) for receiving dietary advice and/or advice on salt reduction. There was a significant reduction (p = 0.016) in numbers of participants with high levels of total serum cholesterol ≥ 5 mmol/ (54.4% vs. 46.3%).

Implementing the Healthy Heart Tool can increase awareness of cardiovascular risk factors in patients with SMI. The intervention increased the proportion of individuals who received dietary and salt reduction advice and decreased the proportion of individuals with high cholesterol levels. However, due to the small numbers, these results should be interpreted with caution. Nonetheless, the findings suggest that the Healthy Heart Tool may be an effective means for improving the management of cardiovascular risk factors in individuals with SMI in typical clinical settings.

The trial was retrospectively registered in ClinicalTrials.gov 29.01.25, ID NCT 06807242.