Lesley-Anne Bissell1,2, Marina Anderson3, Malcolm Burgess4, Kuntal Chakravarty5, Gerry Coghlan6, Raluca B Dumitru1,2, Lee Graham7, Voon Ong5, John D Pauling8, Sven Plein7, Dominik Schlosshan7, Peter Woolfson9, Maya H Buch1,2. 1. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds. 2. NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds. 3. Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool. 4. Department of Cardiology, Aintree University Hospital, Liverpool. 5. Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London. 6. Department of Cardiology, Royal Free Hospital, London. 7. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds. 8. Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath. 9. Department of Cardiology Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
Abstract
Objective: Cardiac disease in SSc can manifest in various ways and is associated with a poor prognosis. There is little evidence on how best to detect and manage cardiac disease in SSc. Our objective was to produce an expert consensus best practice pathway for the management of cardiac disease in SSc. Methods: The UK Systemic Sclerosis Study Group set up several working groups to develop a number of consensus best practice pathways for the management of SSc-specific complications, including cardiac disease. A multidisciplinary task force was convened. The guidelines were partly informed by a comprehensive literature review. Results: A best practice pathway for cardiac disease (with a focus on primary cardiac disease) in SSc is presented, including approaches for early detection and standard pharmacological and device therapies. Due to the benefits, shared care and a multidisciplinary approach are recommended. A future research agenda has been formulated in response to the relative lack of understanding of the natural history of primary cardiac disease that was highlighted by the initiative. Conclusion: The physician should be alert to the possibility of cardiac disease in SSc; it is best managed within a multidisciplinary team including both rheumatologists and cardiologists. This pathway provides a reference for all physicians managing patients with SSc.
Objective: Cardiac disease in SSc can manifest in various ways and is associated with a poor prognosis. There is little evidence on how best to detect and manage cardiac disease in SSc. Our objective was to produce an expert consensus best practice pathway for the management of cardiac disease in SSc. Methods: The UK Systemic Sclerosis Study Group set up several working groups to develop a number of consensus best practice pathways for the management of SSc-specific complications, including cardiac disease. A multidisciplinary task force was convened. The guidelines were partly informed by a comprehensive literature review. Results: A best practice pathway for cardiac disease (with a focus on primary cardiac disease) in SSc is presented, including approaches for early detection and standard pharmacological and device therapies. Due to the benefits, shared care and a multidisciplinary approach are recommended. A future research agenda has been formulated in response to the relative lack of understanding of the natural history of primary cardiac disease that was highlighted by the initiative. Conclusion: The physician should be alert to the possibility of cardiac disease in SSc; it is best managed within a multidisciplinary team including both rheumatologists and cardiologists. This pathway provides a reference for all physicians managing patients with SSc.
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