Karim Ladak1, Jomana Hashim2, Matthew Clifford-Rashotte3, Vikas Tandon4, Mark Matsos5, Ameen Patel2. 1. The Hospital for Special Surgery, New York, NY, USA. 2. Department of Medicine, McMaster University, Hamilton, ON, Canada. 3. Department of Internal Medicine, University of Toronto, Toronto, ON, Canada. 4. Department of Cardiology, McMaster University, Hamilton, ON, Canada. 5. Department of Rheumatology, McMaster University, Hamilton, ON, Canada.
Abstract
OBJECTIVE: Rheumatoid arthritis (RA) portends significant cardiovascular morbidity and mortality. We therefore determined how often rheumatologists screened for and managed cardiovascular risk factors in RA patients, and the barriers to doing so. METHODS: We examined 300 patient charts from 10 university-affiliated rheumatology practices, to ascertain if they had been screened, treated and/or referred over a 3-year period. We subsequently distributed a national survey to Canadian rheumatologists to elucidate challenges in performing optimal cardiovascular risk modification. RESULTS: Most patients were screened for hypertension. Forty-one per cent were found to be hypertensive; however, the majority of these patients were neither treated nor referred to another provider for management. A small minority of patients were screened for diabetes and/or hyperlipidaemia, and these were usually not addressed if abnormal. Men were referred more frequently than women. Consistent with these findings, the majority of rheumatologists from the national survey felt that they did not manage cardiovascular risk adequately; 79.4% cited a lack of time as a major barrier, and 82.5% felt that it should be managed by the primary care provider. CONCLUSION: There is marked underdiagnosis and undertreatment of cardiac risk in RA. Several major barriers exist, including lack of time. Most rheumatologists feel that this aspect of care is the responsibility of primary care physicians.
OBJECTIVE:Rheumatoid arthritis (RA) portends significant cardiovascular morbidity and mortality. We therefore determined how often rheumatologists screened for and managed cardiovascular risk factors in RApatients, and the barriers to doing so. METHODS: We examined 300 patient charts from 10 university-affiliated rheumatology practices, to ascertain if they had been screened, treated and/or referred over a 3-year period. We subsequently distributed a national survey to Canadian rheumatologists to elucidate challenges in performing optimal cardiovascular risk modification. RESULTS: Most patients were screened for hypertension. Forty-one per cent were found to be hypertensive; however, the majority of these patients were neither treated nor referred to another provider for management. A small minority of patients were screened for diabetes and/or hyperlipidaemia, and these were usually not addressed if abnormal. Men were referred more frequently than women. Consistent with these findings, the majority of rheumatologists from the national survey felt that they did not manage cardiovascular risk adequately; 79.4% cited a lack of time as a major barrier, and 82.5% felt that it should be managed by the primary care provider. CONCLUSION: There is marked underdiagnosis and undertreatment of cardiac risk in RA. Several major barriers exist, including lack of time. Most rheumatologists feel that this aspect of care is the responsibility of primary care physicians.
Authors: Julia M Weijers; Anne G Semb; Silvia Rollefstad; George D Kitas; Piet L C M van Riel Journal: Rheumatol Int Date: 2020-02-22 Impact factor: 2.631
Authors: Jeffrey R Curtis; Fenglong Xie; Cynthia S Crowson; Eric H Sasso; Elena Hitraya; Cheryl L Chin; Richard D Bamford; Rotem Ben-Shachar; Alexander Gutin; Darl D Flake; Brent Mabey; Jerry S Lanchbury Journal: Arthritis Res Ther Date: 2020-12-04 Impact factor: 5.156