Abstract
BackgroundPatients with rheumatoid arthritis (RA) are known to be at increased risk of vascular disease. It is not known whether screening for vascular risk factors occurs in primary care. The aim of this study was to determine whether guidance advocating cardiovascular screening in RA patients is being implemented in primary care.MethodsThis study was undertaken in a UK primary care consultation database. All patients with a diagnosis of RA between 2000 and 2008, and still registered with the GP practice in 2009 were matched by age, gender and GP practice to three non-RA patients. Evidence of screening for five traditional vascular risk factors (blood pressure, lipids, glucose, weight, smoking) was compared in those with and without RA using logistic regression models. A comparison was also made with diabetes.Results401 RA patients were identified and matched to 1198 non-RA patients. No differences in the overall rates of screening were found (all five risk factors: RA 24.9% vs no RA 25.6%), but RA patients were more likely to have a smoking status recorded (67% versus 62%). In contrast, those with diabetes were up to 12 times as likely to receive vascular screening.ConclusionsDespite the excess risk of vascular disease in patients with RA being of a similar magnitude to that seen in diabetes, patients with RA did not receive additional CVD screening in primary care, although this was achieved in patients with diabetes. More emphasis needs to be placed on ensuring those with RA are actively screened for cardiovascular disease in primary care.
Highlights
Patients with rheumatoid arthritis (RA) are known to be at increased risk of vascular disease
It is well recognised that patients with rheumatoid arthritis (RA) have an increased mortality rate compared to the general population, due mainly to an excess risk of cardiovascular disease (CVD) [1,2,3]
For patients with diabetes this has been translated into UK guidance advocating annual screening and management of CVD risk [11], further supported with vascular risk factor screening for patients with diabetes being incentivised as part of the UK General Practice Quality Outcomes Framework (QOF), ensuring high uptake of screening for these patients [12]
Summary
Patients with rheumatoid arthritis (RA) are known to be at increased risk of vascular disease. It is well recognised that patients with rheumatoid arthritis (RA) have an increased mortality rate compared to the general population, due mainly to an excess risk of cardiovascular disease (CVD) [1,2,3]. This is reflected in both the European League Against Rheumatism (EULAR) and British Society for Rheumatology guidelines, which recommend regular CVD screening and aggressive risk factor management in patients with RA [4,5]. A secondary aim was to compare rates of screening in people with RA to such rates in people with diabetes mellitus, who have increased levels of vascular risk and in whom such screening is incentivised in the UK
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