Statin prescribing, hypertension diagnosis, and hypertension control improved after a rheumatology practice reached out to patients with rheumatoid arthritis (RA) at risk for cardiovascular disease and their primary care practitioners. Researchers reported on the intervention in a study published online in ACR Open Rheumatology.
Cardiovascular disease (CVD) is the leading cause of death in patients with RA, the researchers said.
“Despite guideline recommendations to lower the thresholds for risk factor management in RA, it has been shown that both rheumatologists and primary care physicians identify and manage cardiovascular risk factors less often in patients with RA compared with patients without RA,” they added.
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To test the effectiveness of an effort to improve primary care management of cardiovascular risk factors in patients with RA, researchers searched the rheumatology practice’s electronic health records for potential candidates for hypertension treatment initiation or improvement, statin therapy, or smoking-cessation intervention. On behalf of the rheumatologists, a nonclinician care manager contacted 261 patients, discussed their risk factors, and recommended follow-up with their primary care provider. The care manager then contacted patients’ primary care practices and, later, followed up with patients to see what steps they had taken.
During the intervention, the proportion of patients meeting the preventive cardiology measure for statins rose from 18.4% to 23.8%, the researchers reported. Compared with baseline, the rate of increase was 1.06% higher per month during the outreach period.
The percentage of patients with controlled hypertension rose from 59.1% to 65.9%, according to the study, and the percentage of patients with repeatedly elevated blood pressure levels who had received a hypertension diagnosis rose from 74.8% to 75.5%. Smoking status, meanwhile, was not affected.
“This approach to cardiovascular disease prevention among patients with RA is one approach that practices with sufficient information technology and staffing resources could consider,” the researchers wrote, “and this approach could be tried in other clinical areas that require coordination of care across two disciplines.”
Persell SD, Lee JY, Lipiszko D, et al. Outreach to promote management of cardiovascular risk in primary care among patients with rheumatoid arthritis seen in rheumatology practice [published online January 27, 2020]. ACR Open Rheumatology. doi:10.1002/acr2.11116