Background/Purpose:   Rheumatoid arthritis (RA) raises cardiovascular disease (CVD) risk, yet RA patients underestimate their personal risk. The principle of self-management posits patients will be self-motivated stewards of their health if they have the knowledge, resources, and support to influence their care. We assess how an education handout aimed at improving RA patients’ self-management of CVD risk changes their knowledge, attitudes, and behaviors. We hypothesize it will improve knowledge with little effect on attitudes and behaviors.

Methods: We prospectively recruited RA patients from an outpatient general rheumatology clinic to read a patient education handout and answer three surveys at time of enrollment (week 0), week 1, and week 8. We distributed education handouts after completion of the week 0 survey. Surveys at weeks 0 and 8 contained questions about behavioral risk factors from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System, novel Likert scales ranking patients’ attitudes about CVD risk, and the Heart Disease Fact Questionnaire-Rheumatoid Arthritis (HDFQ-RA), a validated measurement of RA patients’ knowledge of general CVD and RA-specific CVD risk. The survey at week 1 was the HDFQ-RA. Wilcoxon signed-rank test (α=0.05) analyzed changes in HDFQ-RA scores and Likert rankings, while McNemar’s test (α=0.05) analyzed changes in behaviors.

Results: A total of 38 participants completed all surveys and read the handout. Most patients were female (89%), aged 61.5 (±11.9) years old with a mean RA duration of 15.3 (±13.3) years. Based on total HDFQ-RA scores, both general and RA-specific CVD knowledge significantly improved at week 1 and was sustained at week 8 (table 1).

Table 1:

Based on Likert scales, only attitudes regarding the influence of RA disease activity on CVD risk changed (p=0.012). A total of 23 of the 38 participants (73.7%) stated the handout motivated them to make lifestyle changes, and a significant change was noted in exercise at week 8 (p=0.016), but not in smoking cessation or diet (p>0.99).

Conclusion: A patient education handout improved RA patients’ self-management of CVD risk, not only enhancing knowledge but also improving lifestyle self-management, as patients increased their exercise habits over an 8-week period.  Patients also believed that RA management is more important in mitigating their CVD risk after reading the handout.  This data suggests a patient handout can effectively change patients’ understanding of CV risks and influence certain lifestyle factors, such as exercise. Further study is needed to review self-management strategies that may further augment knowledge, attitudes, and behaviors of CVD in RA patients and potentially improve CV risk factors.