Background/Purpose:

Patients with chronic arthritis have a higher risk of cardiovascular (CV) events than the general population. This is possibly due to the combination of a high prevalence of classic cardiovascular risk factors (CVRF) and persistent inflammation due to their rheumatic disease. T2T approaches and other advances have increased our control of disease activity, however, classic CVRF are often monitored and treated exclusively by the GP.

Aim: To describe the implementation of a specific program for patients with chronic inflammatory arthritis based around a nurse-led clinic and aimed at:

1) Detecting classic CVRF and

2) Optimizing the treatment of these classic CVRF

Methods:

Following the EULAR 2010 recommendations, we developed a screening program for CVRF. Patients with the diagnosis of RA, SpA or PsA who were followed up at a single Rheumatology Department were offered participation in this program by their managing rheumatologist. In a single visit to a nurse-led clinic CV risk was evaluated through a clinical interview. Patients were asked about smoking status, diet, exercise, prior diagnosis of hypertension (HBP), diabetes (DM), dyslipemia (Dlp), personal and familial CV events, other comorbidities and their current treatment. Weight, height, BMI, and blood pressure were registered. Laboratory tests were then reviewed. SCORE tables were applied to calculate the CV risk; adjustment of the SCORE in RA patients was performed according to the EULAR recommendations. Those patients who did not achieve their target for the CVRF were sent to the rheumatologist for consultation. In the rheumatology nurse clinic, an educational program was initiated in order to modify diet, exercise, lifestyle and smoking cessation, where appropriate. The project is currently ongoing; preliminary results are presented.

Results:

133 patients (85 female) have been screened at the nurse-led clinic up to June 2015. Mean age was 59.1 years (SD 10.6). Diagnoses of the screened patients were 93 RA, 29 PsA and 11 SpA. At baseline, 11 patients had a history of CV events, 26 patients had a prior diagnosis of DM (9 (35%) with HbA1C>8%), 64 had HBP (32 (50%) with BP>140/90 at the nurse visit), 60 had Dlp (24 (40%) with cholesterol >220mg/dL). 42 patients were active smokers and 48 were obese (BMI>30).

In the patients without prior DM, the nurse clinic detected 4 patients (3/107, 4%) with glycemia ≥126mg/dL. In these patients a new blood test was ordered to confirm the diagnosis of DM. In patients without prior HBP 26 patients (26/69, 38%) had BP>140/90. In patients without prior Dlp 20 patients (18/73, 27%) had total cholesterol levels >220mg/dL and 37 (37/73, 51%) had LDL-cholesterol levels over their therapeutic target.

Overall, this screening strategy allowed the detection of classical CVRF which were previously undetected or poorly controlled (DM, HBP, Dlp) in 105/133 (79%) of the evaluated patients. In all patients, the nurse-led educational program was initiated.

Conclusion:

A nurse led single-visit screening program allows the detection of classic CVRF in a high proportion of patients. If proper treatment for the classic CVF is initiated, this might result in a decrease of CV events with a favorable impact on the general health of chronic arthritis patients.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-role-of-a-nurse-led-clinic-in-the-assessment-and-prevention-of-cardio-vascular-risk/