Gaps in addressing cardiovascular risk in rheumatoid arthritis: assessing performance using cardiovascular quality indicators

Barber, Claire E. H., Esdaile, John M., Martin, Liam O., Faris, Peter, Barnabe, Cheryl, Guo, Selynne, Lopatina, Elena and Marshall, Deborah A. (2016) Gaps in addressing cardiovascular risk in rheumatoid arthritis: assessing performance using cardiovascular quality indicators. Journal of Rheumatology, 43 11: 1965-1973. doi:10.3899/jrheum.160241


Author Barber, Claire E. H.
Esdaile, John M.
Martin, Liam O.
Faris, Peter
Barnabe, Cheryl
Guo, Selynne
Lopatina, Elena
Marshall, Deborah A.
Title Gaps in addressing cardiovascular risk in rheumatoid arthritis: assessing performance using cardiovascular quality indicators
Journal name Journal of Rheumatology   Check publisher's open access policy
ISSN 1499-2752
0315-162X
Publication date 2016-11-01
Year available 2016
Sub-type Article (original research)
DOI 10.3899/jrheum.160241
Open Access Status Not yet assessed
Volume 43
Issue 11
Start page 1965
End page 1973
Total pages 9
Place of publication Toronto, ON, Canada
Publisher Journal of Rheumatology
Language eng
Abstract 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.

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.

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).

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.
Formatted abstract
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.
Keyword Cardiovascular diseases
Health care quality indicators
Primary prevention
Rheumatoid arthritis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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