Background Patients with chronic arthritis have a higher risk of cardiovascular (CV) events than the general population. Possibly this is due to both the high prevalence of classic cardiovascular risk factors (CVRF) and to the persistent inflammation due to their rheumatic disease. T2T approaches and other advances have increased our control of disease activity, however, classic CVRF are often monitored and treated exclusively by the GP.
Objectives To describe the role of a nurse-clinic in the development of a specific program of patients with chronic inflammatory arthritides aimed at:
1) Detecting classic CVRF and
2) Optimizing the treatment of these classic CVRF
Methods Following the EULAR 2010 recommendations, we developed a screening program for CVRF. Patients with the diagnosis of RA, SpA or PsA who were followed up at a single Rheumatology Department were offered participation in this program by their managing rheumatologist. In a single visit to a nurse-led clinic CV risk was evaluated through a clinical interview. Patients were asked about smoking status, diet, exercise, prior diagnosis of hypertension (HBP), diabetes (DM), dyslipemia (Dlp), personal and familial CV events, other comorbidities and their current treatment. Weight, height, BMI, and blood pressure were registered. Laboratory tests were then reviewed. SCORE tables were then applied and adjustment of the SCORE in RA patients was performed according to the EULAR recommendations. Those patients who did not achieve their target for the CVRF were sent to the rheumatologist for consultation. In the rheumatology nurse clinic, an educational program was initiated in order to modify diet, exercise, lifestyle and smoking cessation, where appropriate. The project is currently ongoing; preliminary results are presented.
Results 63 patients (43 female) had been screened at the nurse-led clinic up to January 2015. Mean age was 58.6 years (SD 10.2). Diagnoses of the screened patients were 49 RA, 5 PsA and 9 SpA. At baseline, three patients had a history of CV events, 7 patients had a prior diagnosis of DM, 21 had HBP (13 with poor BP control), 16 had Dlp (5 with a total cholesterol >220mg/dL and 9 with an LDL-cholesterol higher than their therapeutic objective according to the SCORE estimation and European guidelines). 12 patients were active smokers and 24 were obese (BMI>30).
In the patients without prior DM, the nurse clinic detected 3 patients (5/56, 5%) with glycemia ≥126mg/dL. In these patients a new blood test was ordered to confirm the diagnosis of DM. In patients without prior HBP 11 patients (11/42, 26%) had BP>140/90. In patients without prior Dlp 20 patients (20/47, 43%) had total cholesterol levels >220mg/dL and 21 (21/47, 45%) with LDL-cholesterol levels over their therapeutic target.
Overall, this screening strategy allowed the detection of classical CVRF which were previously undetected or poorly controlled (DM, HBP, Dlp) in 43/63 (75%) of the evaluated patients. In all 63 patients, the nurse-led educational program was initiated.
Conclusions A nurse led single-visit screening program allows the detection of classic CVRF in a high proportion of patients. If proper treatment for the classic CVF is initiated, this might result in a decrease of CV events with a favourable impact on the general health of chronic arthritis patients.
Disclosure of Interest None declared