scholarly journals Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators

2016 ◽  
Vol 43 (11) ◽  
pp. 1965-1973 ◽  
Author(s):  
Claire E.H. Barber ◽  
John M. Esdaile ◽  
Liam O. Martin ◽  
Peter Faris ◽  
Cheryl Barnabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Primary Care ◽  
Quality Indicators ◽  
Care Physician ◽  
Pass Rate ◽  
Early Disease ◽  
Cvd Risk ◽  
Systematic Assessment ◽  
Increased Risk ◽  
Low Performance

Objective.Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice.Methods.Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate.Results.There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%–100% for yrs 1 and 2, respectively).Conclusion.Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

scholarly journals Cardiovascular Disease in Rheumatoid Arthritis: Risk Factors, Autoantibodies, and the Effect of Antirheumatic Therapies

2021 ◽  
Vol 14 ◽  
pp. 117954412110287
Author(s):  
Mir Sohail Fazeli ◽  
Vadim Khaychuk ◽  
Keith Wittstock ◽  
Boris Breznen ◽  
Grace Crocket ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Literature Review ◽  
Rheumatoid Factor ◽  
Qualitative Evidence Synthesis ◽  
Cvd Risk ◽  
Rheumatoid Arthritis Risk ◽  
Published Evidence ◽  
Increased Risk

Objective: To scope the current published evidence on cardiovascular risk factors in rheumatoid arthritis (RA) focusing on the role of autoantibodies and the effect of antirheumatic agents. Methods: Two reviews were conducted in parallel: A targeted literature review (TLR) describing the risk factors associated with cardiovascular disease (CVD) in RA patients; and a systematic literature review (SLR) identifying and characterizing the association between autoantibody status and CVD risk in RA. A narrative synthesis of the evidence was carried out. Results: A total of 69 publications (49 in the TLR and 20 in the SLR) were included in the qualitative evidence synthesis. The most prevalent topic related to CVD risks in RA was inflammation as a shared mechanism behind both RA morbidity and atherosclerotic processes. Published evidence indicated that most of RA patients already had significant CV pathologies at the time of diagnosis, suggesting subclinical CVD may be developing before patients become symptomatic. Four types of autoantibodies (rheumatoid factor, anti-citrullinated peptide antibodies, anti-phospholipid autoantibodies, anti-lipoprotein autoantibodies) showed increased risk of specific cardiovascular events, such as higher risk of cardiovascular death in rheumatoid factor positive patients and higher risk of thrombosis in anti-phospholipid autoantibody positive patients. Conclusion: Autoantibodies appear to increase CVD risk; however, the magnitude of the increase and the types of CVD outcomes affected are still unclear. Prospective studies with larger populations are required to further understand and quantify the association, including the causal pathway, between specific risk factors and CVD outcomes in RA patients.

Abstract 274: Primary Care Physician Status is an Important Factor in Addressing Healthcare Disparities in Patients With Cardiovascular Disease

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ryan King ◽  
Dalia Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Logistic Regression ◽  
Primary Care Physician ◽  
Beta Blocker ◽  
Care Physician ◽  
Cardiac Events ◽  
Cvd Risk ◽  
The Mean

Recent improvements in survival and management of patients with cardiovascular disease (CVD) have resulted from timely use of medications such as beta blockers according to established guidelines. Without medical care provided by a primary care physician (PCP), patients may experience a significant healthcare disparity leading to CVD risk factors not being addressed or not receiving effective preventative therapies. If patients do not have a PCP, then their risk of experiencing CVD complications including an acute myocardial infarction (AMI) may be increased without access to appropriate treatment. We hypothesized that the utilization of preventative therapy depends on patient’s ability to have a PCP. Patients who do not have a PCP are less likely to receive a timely prescription of a beta blocker. Data for this study was collected through a retrospective chart review for 250 patients who presented to the Hartford Hospital Emergency Department for an AMI and were subsequently admitted between August 1, 2016 and April 30, 2018. A Chi square, independent t-test, and logistic regression were used for statistical analysis. A total of 17 patients were excluded due to incomplete documentation. The mean age of 233 patients was 64.64 ± 14.03 years old (range 26-89, males-144, females-89). There were 179 (76.8%) of these patients who had a documented PCP. Out of those with a PCP there were 104 (72.2%, of 144) males as compared to 75 (84.3%, of 89) females, p<0.034. Of the 223 with confirmed information about a beta blocker prescription there were 116 (52.0%) using a beta blocker before this admission for AMI and 99 (85.3%, of 116) of them had a PCP. There were 69 (59.5%, of 116) men and 47 (40.5%, of 116) women using a beta blocker. The mean age of patients using a beta blocker was 69.38 ± 12.9 years vs. 58.99 ± 13.08 years for those without a prescription (p < 0.001). A significant association was also found using logistic regression between PCP status and age groups (> 55 y vs < 55 y), p=0.032, gender, p=0.047, and beta blocker use, p=0.018. Our study shows that being prescribed a beta blocker significantly depends on the patient’s ability to have a PCP. Our study shows that among subjects with AMI, having access to a PCP is an important factor in being prescribed a beta blocker. Identifying barriers to PCP access may improve prevention measures and help bridge disparities resulting in major cardiac events such as myocardial infarction.

scholarly journals Could Omega 3 Fatty Acids Preserve Muscle Health in Rheumatoid Arthritis?

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 223
Author(s):  
Kassandra Lanchais ◽  
Frederic Capel ◽  
Anne Tournadre
Keyword(s):  
Rheumatoid Arthritis ◽  
Insulin Resistance ◽  
Fatty Acids ◽  
Density Lipoprotein ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Cvd Risk ◽  
Cardiometabolic Diseases ◽  
Increased Risk ◽  
Muscle Health

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a high prevalence of death due to cardiometabolic diseases. As observed during the aging process, several comorbidities, such as cardiovascular disorders (CVD), insulin resistance, metabolic syndrome and sarcopenia, are frequently associated to RA. These abnormalities could be closely linked to alterations in lipid metabolism. Indeed, RA patients exhibit a lipid paradox, defined by reduced levels of total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol whereas the CVD risk is increased. Moreover, the accumulation of toxic lipid mediators (i.e., lipotoxicity) in skeletal muscles can induce mitochondrial dysfunctions and insulin resistance, which are both crucial determinants of CVD and sarcopenia. The prevention or reversion of these biological perturbations in RA patients could contribute to the maintenance of muscle health and thus be protective against the increased risk for cardiometabolic diseases, dysmobility and mortality. Yet, several studies have shown that omega 3 fatty acids (FA) could prevent the development of RA, improve muscle metabolism and limit muscle atrophy in obese and insulin-resistant subjects. Thereby, dietary supplementation with omega 3 FA should be a promising strategy to counteract muscle lipotoxicity and for the prevention of comorbidities in RA patients.

scholarly journals Cardiovascular risk knowledge in patients of South Asian origin living with rheumatoid arthritis: data from India and the UK

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Kanta Kumar ◽  
Suvrat Arya ◽  
Peter Nightingale ◽  
Tom Sheeran ◽  
Amita Aggarwal
Keyword(s):  
Rheumatoid Arthritis ◽  
South Asian ◽  
South Asians ◽  
Demographic Data ◽  
Cvd Risk ◽  
Asian Origin ◽  
South Asian Origin ◽  
Increased Risk ◽  
The Uk ◽  
Risk Knowledge

Abstract Background South Asians have a higher risk of cardiovascular disease (CVD). Rheumatoid arthritis (RA) increases the risk of premature atherosclerosis. We investigated whether there was a substantial difference in the level of CVD risk knowledge among patients of South Asian origin with RA in India and in the UK. Methods In this cross-sectional survey, patients of South Asian origin with RA from India and the UK were recruited from secondary care settings. Data were collected via Heart Disease Fact Questionnaire-Rheumatoid Arthritis (HDFQ-RA), a validated self-completion questionnaire. The HDFQ-RA was translated into Hindi and piloted among patients from South Asian background before use. Additionally, clinical and demographic data was collected. Results Among 118 patients from each country, 84% were female and they had similar age, education level, employment status and co-morbidities. Patients from India had longer disease duration (5.5 years versus 4.1 years (p = 0.012) whereas those from the UK had higher disease activity score (4.0 + 0.8 versus 3.1 + 0.7, p < 0.01). Regarding modifiable risk factors for CVD only 51.2% from India and 51.3% in the UK were aware of them. However, awareness of the link between RA and increased risk of CVD was even more limited (32.8% in India and 34.4% in UK). Conclusion Patients of South Asians origin with RA from both countries had limited knowledge about CVD risk. There is a need to educate them about CVD risk during consultation, as this will result in better outcomes.

scholarly journals P146 Undertaking an integrated nurse led review (INCLUDE) for patients with inflammatory conditions: does it change management of morbidities?

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Samantha Hider ◽  
Annabelle Machin ◽  
Milica Bucknall ◽  
Kendra Cooke ◽  
Clare Jinks ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Record ◽  
Controlled Trial ◽  
Management Plan ◽  
Lipid Lowering ◽  
Cvd Risk ◽  
Inflammatory Conditions ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Randomised Controlled

Abstract Background People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), are at an increased risk of common comorbidities, such as cardiovascular disease (CVD), osteoporosis and mood problems, which result in poorer patient outcomes. The INCLUDE study assessed the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led, holistic, integrated review in primary care. Methods A pilot cluster RCT was delivered across four general practices. Patients with a Read code for an IRC were recruited by postal invitation. In intervention practices (n = 2), eligible patients were invited to attend a nurse-delivered INCLUDE review - an integrated consultation assessing CVD risk (QRisk2), bone health (FRAX) and mood (PHQ2 and GAD2), using a study-specific computerised template. Patients received an individualized patient management plan, including signposting to additional services as appropriate. Medical record review was undertaken (in consenting participants) at 12 months. We compared primary care contacts (which include consultations, letters and test results) and prescribing rates (of antihypertensives, lipid-lowering, osteoporosis and antidepressant/anxiety medication) at baseline and 12 months. Results 333 patients participated in the study. The mean (SD) age was 68.2 (13.4) years and 200 (60%) were female. Of these 172 (52%) had RA and 88 (26%) had PMR. 154 (46%) reported high blood pressure, 70 (21%) existing anxiety/depression and 37 (11%) osteoporosis. Medical record data was available for 299/333 participants. Participants in intervention practices had more primary care contacts (mean 29 vs 22). Over the 12-month follow-up, there was higher prescribing of all medication classes in participants in intervention practices (see Table), particularly so for osteoporosis medication (baseline 29% vs 12 month 46%). Conclusion Nurse-delivered integrated reviews for patients with IRCs identified a significant comorbidity burden. Practices undertaking these reviews had higher prescribing rates at 12 months following treatment of previously un-identified conditions, suggesting that patients with IRCs would benefit from an integrated care review to identify and manage common morbidities. Disclosures S. Hider None. A. Machin None. M. Bucknall None. K. Cooke None. C. Jinks None. E. Healey None. A. Finney None. K. Cooke None. S. Wathall None. C. Mallen None. C. Chew-Graham None.

Cardiovascular Disease-related Hospital Admissions of Patients with Inflammatory Arthritis

2014 ◽  
Vol 42 (2) ◽  
pp. 188-192
Author(s):  
Jennie Ursum ◽  
Mark M.J. Nielen ◽  
Jos W.R. Twisk ◽  
Mike J.L. Peters ◽  
François G. Schellevis ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admission ◽  
Inflammatory Arthritis ◽  
Hospital Admissions ◽  
High Rate ◽  
Hospital Data ◽  
Cvd Risk ◽  
Dutch Hospital ◽  
Services Research ◽  
Increased Risk

Objective.Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care–based population of patients with IA and controls.Methods.All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data.Results.There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2–2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0–4.9).Conclusion.Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.

Abstract P252: Health Professional Shortage Areas and Their Association With Cardiovascular Risk Factor Prevalence, Awareness, and Control: Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Norrina B Allen ◽  
Mercedes Carnethon ◽  
Penny Gordon-Larsen ◽  
Catarina Kiefe ◽  
Ana Diez-Roux ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Risk Factor ◽  
Health Professional ◽  
Medical Care ◽  
Low Income ◽  
Cvd Risk ◽  
Increased Risk ◽  
And Control ◽  
Neighborhood Ses

Background: Over 65 million Americans live in Primary Care Health Professional Shortage Areas (HPSAs) which are associated with less preventive care, poorer general health and an increased risk for hospitalizations. However, little is known about how living in a HPSA impacts primary prevention for CVD. Methods: We used data from CARDIA, a multi-center cohort study of black and white men and women. Participants who had risk factor data and geocoded addresses available at year 20 (2005) were included in this analysis (n=3479). Primary care HPSAs were defined using data from US HRSA. Diabetes, hypertension and hyperlipidemia prevalence and control were defined according to ADA Guidelines 2000, JNC VI, and ATP III, respectively. Individuals who reported being diagnosed or reported use of medications were considered aware of the risk factor. The prevalence of smoking and obesity was also examined. Neighborhood (census block) characteristics were derived from Census 2000 and ACCRA. Multivariable Poisson models were used to examine the independent association of HPSA residence with each outcome. Results: Over 11% of CARDIA participants live in a HPSA. Residents of HPSAs were more likely to be female (64% vs 56%), African American (81% vs 43%), have low education, and low income. HPSA residents had more difficulty paying for food/basics and medical care, had poorer access to medical care and lived in areas with a higher cost of healthcare and low neighborhood SES. HPSA residents had a higher prevalence of hypertension (PR 1.39, 95% CI 1.18-1.65), obesity (1.30, 1.16-1.45) and smoking (1.72, 1.46-2.03) and were less likely to have their hypertension (0.79, 0.66-0.95) or hyperlipidemia (0.66, 0.44-0.99) controlled as compared to non-residents. The association between HPSA and risk factors prevalence was explained by race and neighborhood SES. The cost of medical care and having a usual source of care were the largest mediators of the association between HPSA residence and risk factor control. Conclusion: The increased prevalence and poorer control of CVD risk factors in HPSAs, can be explained by the demographic and neighborhood characteristics of their residents. Future interventions should be targeted to these high-risk populations found within HPSAs.

Abstract 636: Accelerated Atherosclerosis in the Context of Rheumatoid Arthritis

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Alexandra Bäcklund Bäcklund ◽  
Martina Johansson ◽  
Massimiliano Ria ◽  
Daniel F Ketelhulth ◽  
Panagiota Tsikrika ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Immune System ◽  
General Population ◽  
Atherosclerotic Lesion ◽  
Clinical State ◽  
Lipid Levels ◽  
Cvd Risk ◽  
Lesion Development ◽  
Increased Risk ◽  
Inflammatory State

Atherosclerotic lesion development and acceleration of lesion size, leading to a cardiovascular event can be affected by many factors, where both the immune system and lipid levels have been implicated. It is well recognized that patients with chronic inflammatory diseases, such as rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) compared with the general population. It has also been suggested that CVD presented in RA patients is of an altered, more aggressive, phenotype compared to subjects without RA. Therefore, the investigation of atherosclerosis lesion development during chronic inflammation may lead to novel pathways that are not only relevant to the general population but also able to target this high CVD risk patient group. Thus, there is a need to gain a deeper understanding of how the exacerbated inflammatory state of arthritis affects the atherosclerosis process when both syndromes are presented in the same individual. Such studies are hampered in humans by the influence of different factors, such as the environment and large genetic heterogeneity of the population. We have developed a novel murine model where the human relevant genes of CVD (LDLr, thus increased LDL levels) and RA (MHCII, thus susceptible to collagen-induced arthritis) have been crossed into the common C57Bl6/J strain, enabling both arthritis and atherosclerosis being presented simultaneously in a clinically relevant fashion. This model mirrors the clinical state where the systemic inflammation of arthritis enhances atherosclerosis progression, where mice presenting arthritis have a significant increase in atherosclerotic lesion progression compared with their non-arthritic littermates. Interestingly, there was an inverse correlation with cholesterol levels, but a positive correlation with macrophages, and macrophage associated cytokines but not T cells. This model thus demonstrates that the lipid levels are vital in initiation of lesion development but it is the enhanced innate immune system that is driving the lesion acceleration in a chronic inflammatory state. This novel combined model is now able to be used to investigate altered clinical treatment strategies or novel treatments of atherosclerosis in the context of arthritis

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