Adherence to 11 CV quality indicators in 2 cohorts.* Values are n (%).
| Quality Indicator | Total | Biologics | ERA | |||
|---|---|---|---|---|---|---|
| 1. Communication of increased CV risk in RA: IF a patient has RA, THEN the treating rheumatologist should communicate to the PCP, at least once within the last 2 yrs that patients with RA have an increased CV risk. | 3/158 (2) | 0/62 (0) | 3/96 (3) | |||
| 2A. CV risk assessment: IF a patient has RA, THEN a formal CV risk assessment according to national guidelines should be done at least once in the first 2 yrs after evaluation by a rheumatologist. | 0/150 (0) | 0/58 (0) | 0/92 (0) | |||
| 2B. IF initial assessment suggests intermediate or high risk, THEN treatment of risk factors according to national guidelines should be recommended. | There were no patients with a risk assessment, therefore both the numerator and denominator for this QI was 0. | |||||
| Y1 | Y2 | Y1 | Y2 | Y1 | Y2 | |
| 3A. Smoking status and cessation counseling: IF a patient has RA, THEN their smoking and tobacco use status should be documented at least once in the last yr. | 160/170 (94) | 16/38** (42) | 59/63 (94) | 5/10** (50) | 101/107 (94) | 11/28** (39) |
| 3B. IF they are current smokers or tobacco users, THEN they should be counseled to stop smoking. | 6/35 (17) | 4/17 (24) | 3/8 (38) | 1/4 (25) | 3/27 (11) | 3/13 (23) |
| 4. Screening for HTN: IF a patient has RA, THEN their blood pressure should be measured and documented in the medical record at ≥ 80% of clinic visits. | 98/170 (58) | 105/159 (66) | 21/63 (33) | 45/62 (73) | 77/107 (72) | 60/97 (62) |
| 5. Communication to PCP about a documented high blood pressure: IF a patient has RA AND has a blood pressure measured during a rheumatology clinic visit that is elevated (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg), THEN the rheumatologist should recommend that it be repeated and treatment initiated or adjusted if indicated. | 5/76 (7) | 3/59 (5) | 3/24 (4) | 1/19 (5) | 2/52 (4) | 2/40 (5) |
| 6. Measurement of a lipid profile: IF a patient has RA, THEN a lipid profile should be done at least once in the first 2 yrs after evaluation by a rheumatologist. | 110/159 (69) | 37/62 (59) | 73/97 (75) | |||
| 7A. Screening for diabetes: IF a patient has RA, THEN diabetes should be screened for as part of a CV risk assessment at least once within the first 2 yrs of evaluation by a rheumatologist.† | 100/149 (67) | 34/58 (59) | 66/91 (73) | |||
| Y1 | Y2 | Y1 | Y2 | Y1 | Y2 | |
| 7B. Yearly in intermediate or high risk patients.‡ | 72/132 (54) | 57/119 (48) | 21/50 (42) | 20/44 (45) | 51/82 (62) | 37/75 (49) |
| 8. Exercise: IF a patient has RA, THEN physical activity goals should be discussed with their rheumatologist at least once yearly. | 55/168 (33) | 24/158 (15) | 12/63 (19) | 12/62 (19) | 43/105 (41) | 12/96 (13) |
| 9A. BMI screening and lifestyle counseling: IF a patient has RA, THEN their BMI should be documented at least once every yr. | 11/170 (6) | 6/159 (4) | 6/63 (10) | 6/62 (10) | 5/107 (5) | 0/97 (0) |
| 9B. IF patient is overweight or obese according to national guidelines, THEN they should be counseled to modify their lifestyle. | 10/111 (9) | 5/103 (5) | 1/40 (3) | 2/39 (5) | 9/71 (13) | 3/64 (5) |
| 10. Minimizing corticosteroid usage: IF a patient with RA is receiving oral corticosteroids, THEN there should be evidence of intent to taper off the corticosteroids or reduce to the lowest possible dose. | 56/57 (98) | 28/28 (100) | 25/26 (96) | 18/18 (100) | 31/31 (100) | 10/10 (100) |
| 11. Communication about risks/benefits of antiinflammatories in patients at high risk of CV events: IF a patient has RA AND has established CVD OR is at intermediate or high CV risk AND is receiving an NSAID (or COX-2 inhibitor), THEN a discussion about the potential CV risks should occur and be documented. | 2/23 (9) | 0/17 (0) | 0/4 (0) | 0/6 (0) | 2/19 (11) | 0/11 (0) |
↵* QI are reported either over a 1- or 2-year measurement basis (as indicated). The denominators vary for each indicator as shown depending on the eligibility criteria for each denominator criterion as published in Gabriel and Crowson9 and rationale for exclusion from the denominators is available upon request. Overall, there were 11 patients who were not eligible for inclusion in any of the denominators for indicators in Year 2 because of lack of followup or new incident CVD after Year 1.
↵** Denominator for this indicator in Year 2 does not include patients who were documented to be nonsmokers in Year 1.
↵† The final part of this indicator “AND if screening is abnormal, this information should be communicated to the PCP for appropriate followup and management if indicated” was not reported on because of very small sample sizes in the denominator.
↵‡ Patients at high or intermediate risk for diabetes include patients with the following risk factors: family history of type 2 diabetes in a first-degree relative, history of metabolic syndrome, obesity or overweight (BMI ≥ 25 kg/m2), steroid use, history of gestational diabetes or a macrosomic infant, history of impaired fasting glucose (≥ 6.1 mmol/l) or HbA1C ≥ 6.0%, history of HTN (blood pressure ≥ 140/90 mmHg), member of a high-risk population (e.g., Aboriginal, Asian, Hispanic, South Asian, African, Pacific Islanders), or high risk based on validated diabetes risk calculators or high or intermediate CV risk based on CV risk calculators (e.g., Framingham Risk Score). CV: cardiovascular; ERA: early rheumatoid arthritis; RA: rheumatoid arthritis; PCP: primary care physician; HTN: hypertension; BMI: body mass index; CVD: CV disease; NSAID: nonsteroidal antiinflammatory drugs; Y1: Year 1; Y2: Year 2; QI: quality indicator; COX-2: cyclooxygenase-2.