Rheumatoid arthritis
Lipid Testing in Patients with Rheumatoid Arthritis and Key Cardiovascular-Related Comorbidities: A Medicare Analysis

https://doi.org/10.1016/j.semarthrit.2012.01.005Get rights and content

Objective

For patients with rheumatoid arthritis (RA) and comorbid cardiovascular disease (CVD), diabetes, or hyperlipidemia, annual lipid testing is recommended to reduce morbidity and mortality from comorbidities. Given trends encouraging complex patients to receive care in “medical homes,” we examined associations between regularly seeing a primary care provider (PCP) and lipid testing in RA patients with cardiovascular-related comorbidities.

Methods

We performed a retrospective cohort study examining a 5% random USA Medicare sample (2004-06) of beneficiaries over 65 years old with RA and concomitant CVD, diabetes, or hyperlipidemia (n = 16,893). We examined the relationship between receiving lipid testing in 2006 and having at least 1 PCP visit per year in 2004, 2005, and 2006 using multivariate regression.

Results

Ninety percent of patients had prevalent CVD; 46% had diabetes, and 64% had hyperlipidemia. However, annual lipid testing was only performed in 63% of these RA patients. Thirty percent of patients saw a PCP less than once per year, despite frequent visits (mean >9) with other providers. Patients without at least 1 annual PCP visit were 16% less likely to have lipid testing. Increased age, complexity scores, hospitalization, and large town residence predicted decreased lipid testing.

Conclusions

Despite comorbid CVD, diabetes, or hyperlipidemia, 30% of Medicare RA patients saw a PCP less than once per year, and 1 in 3 lacked annual lipid testing. Findings support advocating primary care visits at least once per year. Remaining gaps in lipid testing suggest the need for additional strategies to improve lipid testing in at-risk RA patients.

Section snippets

Setting and Participants

In this retrospective cohort study, beneficiaries age 65 and older continuously enrolled and alive in 2004-06 were identified from a 5% random USA Medicare sample obtained from the Medicare Chronic Condition Warehouse dataset (12). Patients were determined to have RA if they had 2 or more International Classification of Diseases, ninth edition (ICD-9) codes for RA (714.0 to 714.33) on inpatient or outpatient claims at least 2 months apart during a 24-month period (2004-05) based on a previously

Descriptive Characteristics

Among over 25,000 Medicare RA patients, 16,893 (67%) had CVD, diabetes, or hyperlipidemia, and thus were included in our sample of those eligible for annual lipid testing. Seventy-five percent of the sample were women; 84% were white/Caucasian, and the mean age was 74.6 years (Table 1). Of those with RA and at least 1 qualifying comorbid condition, 90% had baseline CVD, 46% had diabetes, and 64% had hyperlipidemia. During the observed period, 64% were hospitalized at least once. The 2004

Discussion

In our study, two-thirds of Medicare RA patients had indications for annual lipid testing including 90% with prevalent CVD, 46% with diabetes, and 64% with hyperlipidemia. More than one-third of eligible patients lacked appropriate lipid testing despite the presence of both traditional CVD risk factors and RA compounding CVD risk. Moreover, all of these patients should be seen in primary care at least once per year to assess comorbidities, yet 30% were not. Patients with RA who did see their

Acknowledgments

The authors would like to thank Robert Purvis for meticulous data preparation, and Lauren Fahey and Colleen Brown for manuscript preparation.

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    This project was supported by a training grant and partnership with the Health Innovation Program and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW-ICTR), Grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health. Additional support was provided by the UW School of Medicine and Public Health from the Wisconsin Partnership Program. The authors have no potential conflicts of interest. The Health Innovation Program assisted with data management and manuscript preparation.

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