Implementing an Electronic Medical Record-Based Reminder for Cardiovascular Risk Screening in Rheumatoid Arthritis

Area of Science:

• Rheumatology
• Cardiology
• Health Informatics

Background:

• Cardiovascular disease (CVD) is a leading cause of mortality in rheumatoid arthritis (RA) patients.
• Systematic CVD risk assessment is often inadequate in RA management.
• Tertiary care centers face challenges in integrating CVD risk screening into routine RA care.

Purpose of the Study:

• To evaluate the effectiveness of an electronic medical record (EMR)-based reminder system.
• To assess the impact of EMR reminders on CVD risk screening by rheumatologists and primary care providers in RA patients.
• To determine changes in lipid screening, blood pressure, and obesity rates post-intervention.

Main Methods:

• An EMR-based reminder system was implemented in December 2013 for RA patients (ICD-9 code 714.0).
• The reminder included key cardiovascular risk factors: body mass index, blood pressure, and lipid profiles.
• Lipid screening rates, BP, and obesity were compared pre- and post-implementation; logistic regression identified screening predictors.

Main Results:

• Lipid screening rates were 50% pre-implementation and 46% post-implementation (P=0.58), showing no significant improvement.
• No significant improvements were observed in blood pressure or obesity rates after the EMR reminder implementation.
• Older age and a history of diabetes mellitus were associated with higher odds of lipid screening post-intervention.

Conclusions:

• The implemented EMR reminder did not enhance cardiovascular disease risk screening among rheumatoid arthritis patients.
• Barriers to effective CVD screening in RA require further investigation.
• Educational initiatives for patients and providers regarding RA-associated CVD risks are necessary.