Background: The updated EULAR cardiovascular risk management (CVRM) guideline recommends cardiovascular disease risk assessment at least once every five years in all patients with rheumatoid arthritis (RA).1 A literature search indicates that this guideline is marginally applied in clinical practice.2 An important factor explaining dissimilarities in the quality of CVRM could be the different strategies being used to implement this guideline in daily care.
Objectives: This study describes the differences in cardiovascular risk identification and management for patients with RA between outpatient clinics of the members of the Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA).
Methods: A questionnaire was sent to all members of ATACC-RA, which included 16 questions about ‘the organisation and responsibility of CVRM in their hospital’, ‘the screening of cardiovascular risk factors’, ‘communication about CVRM between medical professionals’ and ‘availability of data regarding CVRM’.
Results: Six out of eight outpatient clinics reported that they work according the EULAR CVRM recommendations. Three strategies to organise CVRM in daily practice could be distinguished: 1) The treating rheumatologist performs CVRM during the outpatient visits; 2) Cardiologists, rheumatologists and/or a general practitioners co-operate in a cardio-rheuma-clinic/team with different tasks and responsibilities and 3) the general practitioner screens and treats cardiovascular risk factors. Six outpatient clinics reported that they have (digital) data about the current CVRM status of their RA patients and are willing to share them to compare the quality of the CVRM care between the different strategies.
Conclusions: Each cardiovascular risk management strategy was based on agreements between medical professionals about who is responsible to perform CVRM. However, each strategy is also (partly) dependent of the national healthcare system and financial resources. Independent of how CVRM is organised, communication and feedback between medical professionals about the current CVRM status of each RA patient, are important factors to perform CVRM adequately. Further analyses on the effectiveness of the various systems are warranted.
References 1. Agca R, Heslinga SC, Rollefstad S, 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 diseases2016. doi:10.1136/annrheumdis-2016-209775
2. Weijers JM, Rongen-van Dartel SAA, Hoevenaars DMGMF, et al. Implementation of the EULAR cardiovascular risk management guideline in patients with rheumatoid arthritis: results of a successful collaboration between primary and secondary care. Annals of the rheumatic diseases2017. doi:10.1136/annrheumdis-2017-212392
Disclosure of Interest: None declared
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