Background To reduce the risk of cardiovascular disease in rheumatoid arthritis (RA) patients, adequate cardiovascular risk management (CVRM) is necessary. CVRM implies assessment, treatment and monitoring of cardiovascular risk factors1. The updated EULAR guideline states that cardiovascular risk assessment should be considered at least once every five years in all patients with RA2. A few studies show suboptimal risk management in daily practice in selected groups of patients.
Objectives This study aims to describe current performance of the CVRM recommendation in a hospital based RA population in the South of the Netherlands. In this region, general practitioners (GPs) and rheumatologists closely collaborate into manage RA patients' cardiovascular risk.
Methods Due to the collaboration, CVRM is performed as a part of a transmural care program. The rheumatologist informs the GP when a patient has been diagnosed with RA. The patient is placed on a list for CVRM to be screened by a specialised nurse practitioner. As a part of the collaboration, laboratory results requested by the GPs and rheumatologists are collected in one digital patient record system. This system is used to check whether the RA patient's lipid profile was determined in the previous five years. If not, a letter with the listed patient is sent to the GP a reminder for screening the patient. In this study, we checked six months later whether lipid testing was ultimately performed.
Results In 70% (n=475) of all 679 RA patients (mean age 63 (SD 9 years), 68% women and median disease duration of 7 years (IQR 3–11)) a lipid profile was determined in the previous five years.
Of the 204 non-screened RA patients, 98 had been screened after sending the letter to their GP (+48%), see Figure 1. No differences in gender and disease duration were found between the screened and non-screened patients (p=.46 and p=.25 respectively). By contrast screened patients were 10 years older compared to the non-screened patients (66 year (SD12) vs 56 (SD 15) year, p<0.0001).
Conclusions As a result of the collaboration between GPs and rheumatologists, 70% of all RA patients was screened for CVRM. A small intervention, sending a reminding letter to the GP, increased this percentage even further, to 84%. This collaboration can be seen as a good practice to provide care in line with the EULAR guideline.
Barber CE et al. Best practices for cardiovascular disease prevention in rheumatoid arthritis: a systematic review of guideline recommendations and quality indicators. Arthritis care & research. 2015;67(2):169–79.
Agca R et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Annals of the rheumatic diseases. 2016.
Disclosure of Interest None declared