Background Patients with rheumatic diseases (RD) have an increased mortality risk compared to the normal population, mainly due to cardiovascular (CV) disease. Only a proportion of this risk increase seems explained by traditional cardiovascular risk factors. It is therefore difficult to identify patients with RD at high risk.
Objectives We aimed to identify high risk patients for CV diseases and mortality by a screening program that is suitable for clinical practice in rheumatology.
Methods 612 consecutive patients attending the rheumatology outpatient department of the University Hospital underwent a comprehensive CV risk assessment including history taking, patient questionnaires, ECG, and laboratory measurements including natriuretic peptides (NTproBNP). Screening was regarded positive if any of the following was present: European CV disease risk assessment Score (SCORE) ≥3% or NTproBNP≥200 pg/ml or any pathological ECG pattern.
Results The patient population comprised patients with rheumatoid arthritis (RA, n=359) or various systemic autoimmune diseases (SAID, n=253) including connective tissue disease (n=157) and vasculitis (n=32). SCORE was ≥3% in 31%, 20% of the patients had a NTproBNP level ≥200 pg/ml, and 16% had a pathological ECG. Patients were followed for a median of 5.5 years. The figure shows KM-plots for the 3 screening strategies, and unadjusted hazard ratios with 95%CI. In an age- and sex-adjusted multivariable model, only NTproBNP≥200 pg/ml conferred independent prognostic information with HR 2.4 (1.10-5.39, P=0.028) and an area under the ROC curve of 82%.
Conclusions RD patients at high risk for death can be identified using simple screening tools. Particularly, patients with a SCORE ≥3% or NTproBNP ≥200 pg/ml are at high risk for death, justifying further diagnostics and closer long-term follow-up.
Disclosure of Interest None Declared
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