Background Increased rates of morbidity and mortality in rheumatoid arthritis have been attributed to higher risk of cardiovascular events.1-3 For this reason, patients should be assessed annually to calculate, address and minimise their cardiovascular risk factors. The European League of Action against Rheumatism has 10 recommendations in the assessment of cardiovascular risk.4 We have conducted a retrospective study of 205 patients with rheumatoid arthritis to see whether we are following the criteria.
Objectives This study was undertaken in order to ascertain whether patients with rheumatoid arthritis have their cardiovascular risk assessed at least once per year by either a doctor or specialist nurse in rheumatology clinic and cardiovascular risks are addressed appropriately.
Methods This was a retrospective study. A list of 205 patients was generated at random from the clinical coding department. Data was then collected from notes and computer reporting system. (Cerner EPR)
Results No patients had a formal cardiovascular risk assessment undertaken by the rheumatology department within the last 12 months. 50% of patients had a pre-existing risk factor for cardiovascular disease. 98% of patients had blood pressure recorded in the last 12 months and 42% were recorded to have high blood pressure. Those who were hypertensive, 88% were receiving treatment for hypertension. 60% had cholesterol recorded and 24% of these were found to have high cholesterol. Of those with high cholesterol, only 60% were on treatment. 44% had plasma glucose or fingerpick glucose recorded and 30% were found to have high blood sugars. All of those with high blood sugars were on appropriate treatment. 37.5% of patients had been on glucocorticoids had no documented glucose recording and 15% of those who had been on glucocorticoids had high blood sugars and were appropriately treated. Initial documentation of risk factors was variable; diabetes mellitus was the most frequently recorded.
Conclusions Cardiovascular risk is currently only partly assessed in rheumatology outpatient clinics. Improvements need to be made in documentation of risk factors and calculation of risk scores. This study highlights the need for clarity between primary and secondary care physicians. Rheumatoid arthritis is a multisystem disease and therefore the specialist should adopt a holistic approach, which includes the assessment of cardiovascular disease; however cardiovascular risk assessments have traditionally been the domain of primary care through the quality outcomes framework. In order to improve standards for our patients, we propose a standardised risk assessment to be completed at baseline for all patients seen in the specialist rheumatology setting which can be updated on an annual basis.
Avina-Zubieta, et al. Arthritis and Rheumatism 2008 (59) 1690-7
Lindhardsen, et al. BMJ 2012;344:e1257
Han C, Robinson DWJ, Hackett MV, et alJ Rheumatol 2006;33
EULAR recommendations, Ann Rheum Dis 2010;69:325-335 doi:10.1136/ard.2009.113696
Disclosure of Interest None Declared