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Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel
Claire E H Barber1, Deborah A Marshall1, Nanette Alvarez1
1From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
Insights
Rheumatoid arthritis patients face high cardiovascular disease (CVD) risk. New quality indicators (QI) for rheumatology clinics were developed to improve CVD screening and management in these patients.
Area of Science:
- Rheumatology
- Cardiology
- Public Health
Background:
- Patients with rheumatoid arthritis (RA) exhibit an elevated risk of premature cardiovascular disease (CVD).
- Effective screening and management strategies for CVD in RA patients are crucial.
Purpose of the Study:
- To develop and validate quality indicators (QI) for cardiovascular disease (CVD) screening and care within rheumatology clinical settings.
- To enhance the early detection and management of CVD risk factors in individuals with rheumatoid arthritis.
Main Methods:
- A systematic literature review identified best practices for CVD risk reduction in RA and general populations.
- A Canadian expert panel (rheumatologists, cardiologists) refined candidate QI.
- An international multidisciplinary panel (health professionals, patients) validated the QI for relevance, validity, and feasibility using a modified Delphi approach.
Main Results:
- Eleven quality indicators (QI) for CVD care in RA patients were finalized.
- The QI address key areas including risk communication, assessment, smoking cessation, hypertension, dyslipidemia, diabetes, exercise, BMI, corticosteroid use, and NSAID risk-benefit communication.
- The developed QI were rated as highly relevant, valid, and feasible by the expert panel.
Conclusions:
- Eleven QI for cardiovascular disease care in rheumatoid arthritis patients have been successfully developed.
- These QI are considered highly relevant, valid, and feasible by an international multidisciplinary panel.
- The QI provide a framework for improving CVD screening and management in rheumatology clinics.
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.
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