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Participation in cardiovascular screening consultations, the who, when and why - A cohort study on patients with
Julie Katrine Karstensen1,2,3, Ann Bremander4,5,6,7, Jeanette Reffstrup Christensen8,9,10
1Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. jkarstensen@danskgigthospital.dk.
Insights
Most rheumatoid arthritis patients attend initial cardiovascular risk screening. However, only half of high-risk patients attend follow-up screenings, indicating a need to understand adherence barriers.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Public Health
Background:
- Systematic cardiovascular (CV) risk assessment is recommended for rheumatoid arthritis (RA) patients.
- Danish hospitals have offered RA patients CV risk assessment since 2011, with high-risk patients invited for follow-up.
- Understanding participation and adherence is crucial for optimizing CV risk management in RA.
Purpose of the Study:
- To explore participation in systematic CV risk assessment among RA patients.
- To identify differences between low and high CV risk RA patients.
- To investigate factors associated with adherence to follow-up screenings among high-risk RA patients.
Main Methods:
- Retrieved data from 2,222 RA outpatients (2011-2021), focusing on 1,522 eligible patients under 75.
- Utilized the modified Systematic Coronary Risk Evaluation (mSCORE) to assess 10-year CV death risk.
- Employed logistic regression, Wilcoxon rank sum, and chi-squared tests to analyze risk factors and adherence.
Main Results:
- Most eligible RA patients (1,149/1,522) accepted initial CV screening; 91 declined.
- High-risk patients exhibited longer disease duration, higher triglycerides, HbA1c, pain, and HAQ scores.
- High-risk patients were more likely to decline follow-up (43% vs. 28%); those declining follow-up were older and had shorter disease duration.
Conclusions:
- Initial CV screening is well-accepted by RA patients.
- Adherence to follow-up screening is suboptimal, with only half of high-risk patients attending.
- Disease impact and lifestyle factors did not predict adherence; further research into patient motivations is needed.
Background:
In accordance with the EULAR recommendations, the Danish Hospital for Rheumatic Diseases have systematically invited patients with rheumatoid arthritis (RA) to cardiovascular (CV) risk assessment since 2011. Patients with high risk are invited to a follow-up screening after one year. To optimize the screening and tailor it to individual needs, information about who accepts vs. declines follow-up is needed. Thus, the aim of this study was to explore participation in systematic CV risk assessment among patients with RA. Furthermore, to explore differences between patients with low vs. high risk, and between patients with high risk who accept vs. decline follow-up.
Methods:
Data from 2,222 outpatients with RA in the period 2011-2021 were retrieved, and of these 1,522 were under 75 years and eligible to be invited. To assess the 10-year risk for CV death, the modified Systematic Coronary Risk Evaluation (mSCORE), derived by multiplying the SCORE by 1.5, was used. Logistic regression analyses were used to explore differences in CV risk factors (triglycerides, HbA1c, lifestyle factors) and measures of disease impact (pain, fatigue, patient global assessment, HAQ, EQ-5D-5L) between patients with low vs. high risk. Differences between high risk patients who accepted vs. declined follow-up were analysed using Wilcoxon rank sum test and chi-squared test for groups.
Results:
One thousand one hundred forty-nine received a CV screening invitation and 91 declined participation. Patients with high risk had significantly longer disease duration (OR; 95 CI) (1.017; 1.002-1.032), higher levels of triglycerides (1.834; 1.475-2.280), HbA1C (1.046; 1.020-1.070), pain (1.006; 1.001-1.012), and HAQ-score (1.305; 1.057-1.612) compared to patients with low risk and they more often declined follow-up (43% vs. 28%, p < 0.001). Those who declined a follow-up invitation were older (p = 0.016) and had shorter disease duration (p = 0.006) compared to those who accepted follow-up.
Conclusion:
A first CV screening consultation was accepted by most patients with RA, while only every other patient with high to very high CV risk adhered to a follow-up screening consultation. Neither measures of disease impact nor lifestyle factors were associated with adherence. Further studies are needed to explore the patients' motivation, barriers and facilitators for adherence or non-adherence to a follow-up consultation.
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