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Published on: April 19, 2019
Protocol for the pilot randomized trial of the CArdiovascular Risk assEssment for Rheumatoid Arthritis (CARE RA)
Joan Weiner1,2, Geyanne Lui3, Mackenzie Brown4
1Indiana University, Bloomington, IN, USA.
Insights
This study tested a peer coach intervention for rheumatoid arthritis (RA) patients to improve cardiovascular disease (CVD) risk assessment. The peer coaching approach aims to increase CVD risk assessment and statin initiation in RA patients.
Area of Science:
- Rheumatology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) is the leading cause of death in rheumatoid arthritis (RA) patients, with a 50-60% increased risk.
- Lipid-lowering therapies effectively reduce CVD risk in RA patients with hyperlipidemia.
- Current primary lipid screening rates among RA patients are low (37-45%), highlighting a gap in care.
Purpose of the Study:
- To describe the CArdiovascular Risk assEssment for RA (CARE RA) intervention, a peer coach-led program.
- To educate RA patients about the link between RA and CVD risk.
- To facilitate evidence-based CVD risk assessment and treatment for RA patients.
Main Methods:
- An open-label pilot study comparing a peer coach intervention group with a self-guided curriculum group.
- Participants were randomized 1:1 to either the peer coach or control arm.
- The primary outcome was the rate of CVD risk assessment or statin initiation.
Main Results:
- The study aims to determine if peer coaching increases the frequency of cardiovascular risk assessment compared to self-guided learning.
- Secondary outcomes include assessing patient activation and RA medication adherence.
Conclusions:
- This pilot study will assess the feasibility of the peer coach intervention for a larger trial.
- The CARE RA intervention represents a novel approach using peer coaches to implement evidence-based guidelines for RA patients.
Background:
Cardiovascular disease (CVD) is the most common cause of death among people with rheumatoid arthritis (RA), with an estimated increased risk of 50-60% compared to the general population. Lipid-lowering strategies have been shown to lower CVD risk significantly in people with RA and hyperlipidemia. Thus, CVD risk assessment has an important role to play in reducing CVD among people with RA. Yet currently only 37 to 45% of this population are receiving primary lipids screening. This paper describes the CArdiovascular Risk assEssment for RA (CARE RA) intervention, which is designed to address this issue. CARE RA is a peer coach intervention, that is, an intervention in which a person with RA coaches another person with RA, which is designed to educate people with RA about the relation between RA and CVD risk and to help them obtain evidence-based CVD risk assessment and treatment.
Methods:
This is an open-label pilot study that will test if the participants assigned to complete the CARE RA curriculum with a peer coach will receive a cardiovascular risk assessment more frequently compared to those that complete the CARE RA curriculum by themselves. The CARE RA intervention is guided by Social Cognitive Theory. Participants in the peer coach intervention arm will receive the assistance of a peer coach who will call the participants once a week for 5 weeks to go over the CARE RA curriculum and train them on how to obtain CVD risk assessment. The control arm will complete the CARE RA curriculum without any assistance. Participants will be randomized 1:1 either to the control arm or to the peer coach intervention arm. The primary outcome is a participant's having a CVD risk assessment or initiating a statin, if indicated. Secondary outcomes include patient activation and RA medication adherence. The RE-AIM implementation framework guides the implementation and evaluation of the intervention.
Discussion:
This pilot study will test the feasibility of the peer coach intervention in anticipation of a larger trial. CARE RA pioneers the use of peer coaches to facilitate the implementation of evidence-based treatment guidelines among people with RA.
Trial Registration:
ClinicalTrials.gov NCT04488497 . Registered on July 28, 2020.
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