Abstract
Objective. Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QI) for screening and use in rheumatology clinics.
Methods. A systematic review was conducted of the literature on CVD risk reduction in RA and the general population. Based on the best practices identified from this review, a draft set of 12 candidate QI were presented to a Canadian panel of rheumatologists and cardiologists (n = 6) from 3 academic centers to achieve consensus on the QI specifications. The resulting 11 QI were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity, and feasibility in 3 rounds of online voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology.
Results. Response rates for the online panel were 86%. All 11 QI were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1–9 scale), with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA; CV risk assessment; defining smoking status and providing cessation counseling; screening and addressing hypertension, dyslipidemia, and diabetes; exercise recommendations; body mass index screening and lifestyle counseling; minimizing corticosteroid use; and communicating to patients at high risk of CVD about the risks/benefits of nonsteroidal antiinflammatory drugs.
Conclusion. Eleven QI for CVD care in patients with RA have been developed and are rated as highly relevant, valid, and feasible by an international multidisciplinary panel.
Footnotes
Funded by a grant from the Canadian Institutes for Health Research (CIHR; funding ref. # 129628). Dr. Barber is a PhD candidate and her work is supported by a Health Research Clinical Fellowship from Alberta Innovates Health Solutions 2011–15 as well as a Rheumatology Postgraduate Fellowship funded by UCB Canada, The Canadian Rheumatology Association, and The Arthritis Society from 2011–13, and a Vanier Canada Graduate Scholarship 2014–15. Dr. Marshall is a CIHR Canada Research Chair in Health Services and Systems Research and the Arthur J.E. Child Chair in Rheumatology Outcomes Research.
- Accepted for publication March 27, 2015.
In this issue
