Perspectives of Patients with Inflammatory Arthritis Regarding Cardiovascular Risk: A Qualitative Study

Iris Navarro-Millán^1,2, Sarah Young³, Sally Shurbaji⁴, Chastity McDavid⁴, Anna Cornelius-Schecter², Bernadette Johnson⁴, Andrea Cherrington⁴, Liana Fraenkel⁵, Jeffrey R. Curtis⁴ and Monika M. Safford², ¹Hospital for Special Surgery, New York, NY, ²Weill Cornell Medicine, New York, NY, ³Binghamton University, Binghamton, NY, ⁴University of Alabama at Birmingham, Birmingham, AL, ⁵Yale University, New Haven, CT

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, Cholesterol and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, October 23, 2018

Title: Patient Outcomes, Preferences, and Attitudes Poster II: Patient Perspectives

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Cardiovascular disease (CVD) is the most common cause of death among patients with inflammatory arthritis (IA) such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS). Our purpose was to elicit perspectives of patients with IA to inform the design of a patient-centered intervention for a CVD risk reduction intervention.

Methods: This was a qualitative study guided by Bandura’s Social Cognitive Theory, placing special emphasis on knowledge about the relationship between arthritis and CVD as well as barriers and facilitators to receiving healthcare related to CVD risk such as screening and management for hyperlipidemia. We recruited patients from a single academic center with either RA, PsA, or AS to participate in focus groups. Data were analyzed thematically.

Results: We conducted three focus groups with a total of 17 participants (5 participants in two and 7 participants in one of the focus groups) of mean age 56 (SD+7.7) years; 15 were women; 3 were on a statin; and 1 previously had a stroke. Five themes emerged (Table): 1) Need for more information about IA and its medications; 2) Lack of understanding regarding the association between CVD risk and IA; 3) Holistic approach to CVD risk reduction including lifestyle changes; 4) Possible uses for peer coaches around relevant CVD risk factor mitigation approaches; and 5) Improving doctor-patient communication about IA. In summary, these themes showed that many participants were not aware of the relationship between CVD and IA. They demonstrated interest in learning about IA, IA medication side effects, and prognosis of IA. Participants prioritized learning about IA, its prognosis, and treatment followed by learning about preventive measures for CVD risk within the context of their IA rather than CVD as a separate condition.

Conclusion: Providing a clear understanding about the systemic effects and treatments for IA should be integrated into a CVD risk reduction intervention targeted at patients with IA.

Table: Themes and Key Points That Emerged From Focus Groups of Patients with Inflammatory Arthritis

Theme	Quotes from patients
Need for information about IA and medications	“When I was first diagnosed, as far as the medications and the side effects and what I could expect. Like I said, everything I read was bad, and it didn’t—I’m probably going to take it the rest of my life, and you have to get your blood tested every three months to make sure everything’s looking good.”
Lack of understanding regarding the association between CVD risk and IA	“I never even thought about it. Had no idea that it would even affect my heart like that. I’m still in shock [laughter] that that has to do with the arthritis.”
CVD risk reduction as an integrated lifestyle modification	“They (doctors) know about the medicines and everything, so I’ll ask them, “Is there something’ I could do or take that would help it?” We’ve got to do our part, too. We’ve got to exercise. We got to watch what we eat. Stress. I know stress will cause a lot of stuff to come on.”
Possible uses for peer coaches around relevant CVD risk factor mitigation approaches	“It would’ve been helpful if I would talk to somebody who, maybe, was on the medication and could tell me, “Well, I haven’t had any problems with it,” or, “Yeah, it does this.” I’m sure it affects different people differently.” “I guess if it would involve exercising takin’ a walk, it’d be nice to do it with somebody if they’ve got the same (arthritis)—and do it together, that would be motivating.”
Improving doctor-patient communication about IA	“It’s like, first of all, I don’t care for him (doctor). [Laughter] He’s an older doctor and he’s like, ‘I’m only going to see you for one thing.’ I’m like, ‘No, if I have four things wrong with me, you need to see me for four things.’” “The peer coach could go with you to your appointments and to help you to understand. I’ve thought about that, to completely understand and to help communicate.” “If I’m at home, and all of a sudden, I’m like, ‘Why didn’t I ask her that? Let’s write it down. Then when I go to my peer coach, maybe, with those questions, they can also help me to understand that.”

Disclosure: I. Navarro-Millán, None; S. Young, None; S. Shurbaji, None; C. McDavid, None; A. Cornelius-Schecter, None; B. Johnson, None; A. Cherrington, None; L. Fraenkel, None; J. R. Curtis, None; M. M. Safford, None.

To cite this abstract in AMA style:

Navarro-Millán I, Young S, Shurbaji S, McDavid C, Cornelius-Schecter A, Johnson B, Cherrington A, Fraenkel L, Curtis JR, Safford MM. Perspectives of Patients with Inflammatory Arthritis Regarding Cardiovascular Risk: A Qualitative Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/perspectives-of-patients-with-inflammatory-arthritis-regarding-cardiovascular-risk-a-qualitative-study/. Accessed .

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