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Appropriate cardiovascular disease risk assessment in systemic lupus erythematosus may be lacking in rheumatology
Faranak Esmaeilbeigi1, Janet E Pope2
1Department of Medicine, University of Western Ontario, London, ON, Canada.
Insights
Cardiovascular risk assessment for systemic lupus erythematosus (SLE) patients is inconsistent among rheumatologists, highlighting a need for better communication and standardized care to manage elevated cardiovascular disease (CVD) risk.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Public Health
Background:
- Systemic lupus erythematosus (SLE) is associated with a significantly increased risk of cardiovascular disease (CVD).
- Cardiovascular risk assessment and management are crucial for patients with SLE.
- Current practices among rheumatologists regarding CVD risk assessment in SLE patients are not well-defined.
Purpose of the Study:
- To evaluate the current practices of cardiovascular risk assessment in patients with systemic lupus erythematosus (SLE) among rheumatologists.
- To identify potential gaps in care and areas for improvement in CVD risk management for SLE patients.
Main Methods:
- A cross-sectional survey was conducted using an electronic questionnaire distributed to 425 members of the Canadian Rheumatology Association.
- The questionnaire focused on preventative strategies, risk assessment, and beliefs concerning SLE and CVD, based on established guidelines.
- Responses were analyzed and stratified based on practitioner characteristics.
Main Results:
- A 22% response rate (99 participants) was achieved. While most rheumatologists recognized SLE as a major CVD risk factor and supported risk assessment, a significant portion (42%) were uncomfortable with current guidelines.
- Adherence to recommended screenings was inconsistent: 15% did not check blood pressure at every visit, 32% did not order cholesterol checks, and 34% did not screen for diabetes.
- Communication with family physicians regarding CVD risk in SLE patients was also suboptimal, with 64% not routinely informing them despite believing physicians were unaware of the risk.
Conclusions:
- Cardiovascular risk assessment and preventative strategies for SLE patients are inconsistent among rheumatologists, indicating a significant care gap.
- There is a need for improved communication between rheumatologists and family physicians to address the elevated CVD risk in SLE.
- Standardized approaches to CVD risk assessment and management in SLE patients are warranted.
Objectives:
To determine practices regarding cardiovascular (CV) risk assessment in systemic lupus erythematosus (SLE) amongst rheumatologists.
Methods:
A questionnaire assessing preventative strategies, risk assessment, and beliefs regarding SLE and CV disease was sent electronically to 425 members of the Canadian Rheumatology Association. Questions were based on published recommendations for CV risk management. Responses were stratified based practitioner's characteristics.
Results:
Ninety-nine rheumatologists and trainees responded (22% response rate). Nearly all (91%) believed that SLE is a major CV risk factor, and 68% felt rheumatologists should assess CV risk; whereas 42% were not comfortable with guidelines, 97% felt that family physicians are not aware of the CV risk in SLE but 64% did not routinely inform them in their correspondence. For SLE patients followed: 15% did not check blood pressure at every visit, 32% did not order cholesterol and 34% did not screen for diabetes irrespective of the presence of additional risk factors. Half (54%) would stratify SLE patients as intermediate or high risk when deciding on lipid lowering treatment. For SLE, 45% recommended a target blood pressure of 140/90 and 55% recommended 130/80 as the target.
Conclusions:
CV risk assessment and preventative measures were inconsistent when rheumatologists monitored SLE patients, indicating a care gap. Improved communication between rheumatologists and family physicians with respect to elevated CVD risk in SLE is needed.
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