Background Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) as compared to the general population. Furthermore, RA patients have a comparable increased risk of CVD to that of diabetics and yet are not screened as well. The European League Against Rheumatism (EULAR) recommends that rheumatologists engage in assessing the CVD risks in RA patients, but there are currently no specific recommendations from the American College of Rheumatology (ACR). Multiple barriers such as limited time and lack of familiarity of CVD screening guidelines challenge the feasibility of this practice. Furthermore, recent data suggest that primary care providers fail to assess RA patients consistently or aggressively.
Objectives The project aimed to increase RA patient awareness of CV risks, improve the process for screening and documenting CV risk factors. At National Jewish Health, a tertiary referral center, we implemented an integrated system to provide RA patients direct access to evaluation by a cardiologist for CVD risk assessment.
Methods We reviewed the medical records of all RA patients presenting to our hospital for new or follow up appointment in 2015 when the rheumatology CVD risk assessments began. Charts were reviewed for: baseline characteristics, a chest commuted tomography (CT) scan that included cardiac imaging information and medication use. A board certified cardiologist reviewed the cardiac CT information for the presence or absence of coronary calcifications.
Results There were 683 RA patients seen during the study interval and 251 were screened and referred for CV risk assessment. A significant number of patients are current or past smokers. (Table) The majority are seropositive and have normal lipid and hemoglobin A1C levels. We have recorded an MDHAQ on 75% of the RA patients and 39% have an ASCVD risk score. Prior to this project, we had not done routine assessments or recorded them in our electronic medical records. We found 104/251 (41%) of the patients had a chest CT available for review. 41/104 (39%) had some presence of coronary calcifications on chest CT and 39/104 (37%) were either on or started a statin.
Conclusions RA patients seen in our tertiary hospital were effectively screened for CVD risk and aggressively treated, but we found that not all patients could be screened. Our institution was amenable to the practice changes and implementation among other hospitals may be a feasible option.
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Acknowledgement This project was supported by an Independent Grant for Learning and Change from Pfizer.
Disclosure of Interest None declared