RT Journal Article
SR Electronic
T1 Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance using Cardiovascular Quality Indicators
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.160241
DO 10.3899/jrheum.160241
A1 Claire E.H.  Barber
A1 John M.  Esdaile
A1 Liam O.  Martin
A1 Peter Faris
A1 Cheryl Barnabe
A1 Selynne Guo
A1 Elena Lopatina
A1 Deborah A.  Marshall
YR 2016
UL http://www.jrheum.org/content/early/2016/07/27/jrheum.160241.abstract
AB Objective Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. Methods Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. Results There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%–100% for yrs 1 and 2, respectively). Conclusion Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.