OP0119-HPR WHO ACCEPTS OR DECLINES AN INVITATION TO CARDIOVASCULAR SCREENING – A REGISTER STUDY ON PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

BackgroundAt the Danish Hospital for Rheumatic Diseases, patients with rheumatoid arthritis (RA) have been invited to systematic cardiovascular (CV) risk assessments since 2011, in accordance with the EULAR recommendations.(1). Patients who are assessed to have high or very high risk for CV death according to the modified Systematic Coronary Risk Evaluation (mSCORE) (SCORE multiplied by 1.5) (1, 2) or have known CV disease or diabetes mellitus, are invited to a follow-up screening consultation after one year. Information about who accepts vs. declines the CV screening invitation can help optimize the screening and tailor it to individual needs.ObjectivesI) to explore participation in the systematic CV risk assessment for patients with RA; II) explore differences between patients with high risk who accepted vs. declined a follow-up screening and III) explore differences in additional CV risk factors not included in the mSCORE between patients with low vs. high risk.MethodsData from all outpatients with RA connected to the Danish Hospital for Rheumatic Diseases in the period 2011-2021 were retrieved from the national rheumatology quality database, DANBIO. Differences between patients with a mSCORE (≥5%) who accepted vs. declined a follow-up consultation in terms of triglycerides, long-term blood sugar, lifestyle factors (alcohol consumption, physical activity level and waist circumference) and measures of disease impact (pain, fatigue, patient global assessment, HAQ and EQ-5D-5L) were analysed using Wilcoxon rank sum test and Fisher’s exact test for groups. Crude and multiple regression analyses using the same explanatory variables, were performed to explore differences between patients with a low to moderate (<5%) vs. high to very high (≥5%) risk.ResultsData were retrieved from 2.222 patients, of which 1.608 (72%) had been invited to screening consultations. 614 (28%) had not been invited and of these 139 (23%) were 75 years or older. 354 (22%) declined and 1.254 (78%) patients accepted the invitation. The patients who declined the invitation were older (mean 78.37 (SD 14.82) vs. mean 63.40 (SD 10.88) and had longer disease duration (mean 15.4 (SD 12.05) vs. mean 10.11 (SD 10.64)) compared to patients who had participated in a CV screening consultation. After excluding patients above 70 years of age, 888 patients remained, including patients with known CV disease or diabetes mellitus. Of these, 162 (18%) had a high or very high risk for CV death within ten years and 93 (57%) of these accepted a follow-up screening consultation. There were no significant differences between patients with a mSCORE ≥ 5% who accepted vs. declined a follow-up consultation in any of the studied variables. In the crude analyses, a significant difference was only found between patients with low to moderate vs. high or very high risk in triglycerides OR 1.70 (95% CI 1.20-2.28) and high waist circumference for women, OR 11.90 (95% CI 4.64-30.52). However, no significant differences were found between the two groups in the multivariate analysis.ConclusionEight out of ten patients with RA accepted the first invitation to a CV screening consultation, and 2/3 of the patients with high or very risk for CV death adhered to a follow-up invitation. This study could not identify differences between patients with high risk SCORE who accepted vs. declined a follow-up CV screening. There is a need to explore barriers and facilitators for patients’ adherence to CV screening.