The increased risk for cardiovascular (CV) disease (CVD) in patients with rheumatic joint diseases (RJD) has been well established. However, while programs for prevention of CVD have been developed for other chronic diseases associated with a high CV risk, including diabetes, familial hypercholesterolemia and chronic kidney disease; the CV risk in RJD patients is still poorly managed. The NOrwegain Collaboration on Atherosclerosis in patients with RJD (The NOCAR project) is a national effort to move the theoretical knowledge of increased CV risk in patients with RJD, into actual clinical management of CV risk factors and CVD.
The NOCAR project involves 12 Norwegian rheumatology centres; from Tromsø in north, to Kristiansand in south. The aims of the project are to identify CV risk factors, calculate CV risk and ensure referral of RJD a patients at increased risk to further evaluation and initiation of adequate CV preventive measures. Accordingly, all centres have implemented an electronic journal program (GoTreatIt-rheuma [GTI]) featuring a designated CV module that facilitates the recording of CV risk factors. GTI also automatically calculates future risk of CVD by using the Systemic Coronary Risk Evaluation (SCORE) algorithm.
In a busy rheumatology outpatient setting, the feasibility of a CV prevention project relies upon a non-time consuming, stream lined design. Thus, all visits in the NOCAR project is connected to annual visits in already ongoing rheumatology studies. Furthermore, the project focuses on three simple, key elements for CV risk evaluation:
1. Patient self-reported questionnaires on CV risk factors, medication and comorbidity (est. time 3-5 min)
2. Cholesterol values, measured as part of standard rheumatology blood works (est. time 2 min)
3. Brachial blood pressure, measured as part of the nurse consultation (est. time 4 min)
Furthermore, nurses are instructed in delivering brief advice and brochures on healthy diet and smoking habits to all patients (est. time 3min). In a standardized letter, rheumatologists refer all patients with a calculated CV risk by SCORE ≥5% to a primary care physician or a cardiologist for the initiation of preventive measures.
Finally, through biannual informational campaigns directed at rheumatology health personnel in the participating 12 centres, the NOCAR project has the potential to expand the daily clinical rheumatology perspective to also include CV comorbidity.
Disclosure of Interest None declared
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