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Abstract
The aim was to study the different strategies used to implement cardiovascular risk evaluation and management for patients with rheumatoid arthritis (RA) in daily clinical practice. A questionnaire survey was performed among both the members of the international Trans-Atlantic Cardiovascular Risk Consortium for Rheumatoid Arthritis (ATACC-RA) as well as the Survey of cardiovascular disease risk factors (CVD-RF) in patients with RA (SURF-RA) group. The questionnaire included 18 questions with the overarching topics: (1) organization and responsibility of cardiovascular risk management (CVRM); (2) screening of CVD-RFs; (3) overview current CVRM status; and (4) availability of data regarding CVRM. Based on the answers, two researchers (JW, PR) independently categorized the different strategies. Thirteen out of 27 rheumatology centers responded to the questionnaire. One rheumatology center did not have organized CVRM for their RA patients. Among the other centers, three strategies to organize CVRM in daily practice were distinguished: (1) the rheumatologist performs CVRM during outpatient visits (n = 6); (2) cardiologists and rheumatologists co-operate in a cardio-rheuma-clinic/team with different tasks and responsibilities (n = 3); and (3) the general practitioner screens and intervenes on CVD-RFs (n = 3). Each CVRM strategy was based on agreements between medical professionals and was also dependent on the national healthcare system and available financial resources. Three strategies were identified for CVRM implementation in daily clinical practice based on who is primarily responsible for performing CVRM. More research is warranted to compare their relative merits and effectiveness in relation to CVRM.
Highlights
It has already been known for decades that patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular diseases (CVD), such as myocardial infarctions, cerebrovascular accidents, and congestive heart failures compared with the general population [1,2,3]
Six out of 13 respondents reported that their outpatient clinic has procedures according to annational guideline for cardiovascular risk management (CVRM), with the 2016 CVRM European League Against Rheumatism (EULAR) recommendation most frequently used [12]
Two other respondents reported that they had agreements between healthcare professionals [rheumatologists and general practitioners (GPs)]: these agreements were derived from the EULAR recommendations [12] or European Society of Cardiology guidelines for CVD prevention [19]
Summary
It has already been known for decades that patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular diseases (CVD), such as myocardial infarctions, cerebrovascular accidents, and congestive heart failures compared with the general population [1,2,3]. International guidelines have been developed, such as the guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA) [6,7,8], the European Society of Cardiology (ESC) guidelines for cardiovascular risk management (CVRM) [9, 10], and the European League Against Rheumatism (EULAR) recommendations for CVRM in patients with RA and other forms of inflammatory joint diseases [11, 12]. In addition to pharmacological therapy, lifestyle modification including a healthy diet, physical activity and smoking cessation should be supported [12] These CVRM guidelines, and guidelines in general, are intended to improve the quality of care. Until now, it is unknown which approaches are used to organize CVRM according to the recommendations This questionnaire survey is the first step to clarify this variation by identifying various systems for CVD risk evaluation and management in patients with RA in rheumatology expert centers across the world. It was guaranteed that the data were not published with recognizable rheumatology centers
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