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Utilisation of cardiovascular preventive services in a rheumatoid arthritis population-based cohort
Daniel Montes1, Cassondra A Hulshizer2, Elena Myasoedova2,3
1Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Rheumatoid arthritis patients show comparable cardiovascular disease (CVD) screening rates to the general population. However, those with RA as their only risk factor receive less screening for diabetes and hyperlipidaemia, indicating a need for improved care.
Area of Science:
- Rheumatology
- Cardiology
- Preventive Medicine
Background:
- Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD).
- Understanding the utilization of CVD preventive services in RA patients is crucial for optimizing care.
- Comparative analysis with a non-RA population can highlight disparities in screening practices.
Purpose of the Study:
- To compare the utilization of cardiovascular preventive services between patients with rheumatoid arthritis (RA) and a matched non-RA population.
- To assess CVD screening rates for diabetes mellitus (DM), hypertension, and hyperlipidaemia in RA patients without these risk factors compared to non-RA patients with one risk factor.
Main Methods:
- A cohort study included adult RA patients and matched non-RA comparators from eight Minnesota counties.
- Screening rates for DM, hypertension, and hyperlipidaemia were compared between groups using Cox proportional hazards models.
- Matching criteria included sex, age, and county of residence.
Main Results:
- Patients with RA had higher rates of diabetes mellitus (DM) and hypertension screening compared to non-RA patients.
- Hyperlipidaemia screening rates were similar between RA patients and their non-RA counterparts.
- RA patients without traditional CVD risk factors were less likely to undergo screening for DM and hyperlipidaemia than non-RA patients with one risk factor.
Conclusions:
- Cardiovascular disease (CVD) preventive screening is utilized at rates comparable to the general population among RA patients.
- Opportunities exist to improve CVD risk factor screening in RA patients, particularly those with RA as their sole identified risk factor.
- Enhanced screening protocols for RA patients could mitigate CVD risk more effectively.
Objectives:
The objective is to examine utilisation of cardiovascular preventive services in patients with rheumatoid arthritis (RA), compared with a non-RA population, and to examine cardiovascular disease (CVD) screening rates among RA patients without diabetes mellitus (DM), hypertension or hyperlipidaemia to non-RA patients with one of these diagnoses.
Methods:
All ≥18-year-old patients with an RA diagnosis living in one of eight Minnesota counties on 1 January 2015 were included and matched (1:1) by sex, age and county to non-RA comparators. Rates of screening for CVD risk factors, including DM (ie, glucose), hypertension (ie, blood pressure) and hyperlipidaemia (ie, lipids), were compared between groups using Cox models.
Results:
The study included 1614 patients with RA and 1599 non-RA comparators. DM screening was more common among patients with RA (HR: 1.10, 95% CI: 1.01 to 1.19), as was hypertension screening (HR: 1.37, 95% CI: 1.24 to 1.52). Hyperlipidaemia screening in RA was similar to comparators (HR: 0.99, 95% CI: 0.89 to 1.10). Conversely, patients with RA and no CVD risk factors had a lower probability of undergoing diabetes (HR: 0.67, 95% CI: 0.57 to 0.78) and hyperlipidaemia screening (HR: 0.65, 95% CI: 0.54 to 0.79) than non-RA patients with only one CVD risk factor diagnosis. Hypertension screening was similar between both groups.
Conclusions:
RA patients undergo CVD preventive screening at rates at least comparable to the general population. However, patients with RA as their sole CVD risk factor were less likely to undergo screenings, despite an equivalent-to-higher risk as the traditional CVD risk factors. These findings demonstrate opportunities for improvement of RA patient care.
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