Background/Purpose: A systematic screening of multimorbidities is performed since 2014 at the Montpellier University Hospital in patients with chronic inflammatory rheumatic diseases (IRD). The objective of this work was to assess the impact of this screening on management of patients and hospitalization rate during a 3-year follow-up.

Methods: Patients with IRD who benefit from the screening program (index date) were identified in the French national health database SNDS and matched to 3 controls on age, sex, IRD and disease’s duration. The primary end-point was a composite score assessing the deliverance of comorbidity preventive medications (vaccines, anti-platelet therapies, hypolipemiants, anti-osteoporotic drugs) during the year following the index date. Secondary outcomes were the consultation with cardiologist/pneumologist, all-cause hospitalization rate, hospitalization for fractures, cardiovascular events or infections. Odds ratios (CI95%) were calculated, with multivariate logistic regression adjusted on medical history (hypertension, diabetes, heart failure, CV disease, lung disease, osteoporotic fractures) and medications related to IRD or included in the primary endpoint in the preceding year.

Results: 441 patients who participated to the screening program (exposed) were identified in the national database and matched with 1323 unscreened patients (controls). 73.9% had rheumatoid arthritis, 18,1% ankylosing spondylitis and 7,9% psoriatic arthritis. Exposed patients had significantly less diabetes than controls (4,5 vs 7,6 %) and received significantly less glucocorticoids (36,5 vs 42,1%), more csDMARDs (56,9 vs 42,8%) and more bDMARDs (57,4 vs 32,6%) than controls. The use of drugs assessed in the primary endpoints was more frequent in the year preceding inclusion in the exposed group compared to controls (58.4 vs 45.3%). Exposed patients fulfilled primary endpoint almost twice more than controls (OR=1.9 [1.5-2.4]). The instauration of comorbidity preventive medications remained significantly more frequent after adjusting on medical history and anterior medications (OR=1.5 [1.1-2.1]). After adjusting on baseline comorbidities, exposed patients consulted significantly more cardiologist or pneumologist in the year following the screening than controls (OR=1.6 [1.2-2.1]). Controls had a 3-time increased risk of all-cause hospitalization (3.1 [2.1-4.6]) at 1-year follow-up that remained significant after adjustment (2.4 [1.5-4.0]). Controls had a significantly higher risk of hospitalization for cardiovascular events (2.1 vs 0.3%), infections (6.8 vs 3.6%) and emergency admission (20.3 vs 10.6%) than controls at 2-year follow-up.

Conclusion: Recommendations given during the comorbidity screening program were applied with an increase of comorbidity preventive medication intake and more consultations with the specialists. After adjusting on comorbidities and medications at baseline, we observed a decreased risk of hospitalization rates that could reflect the positive impact of performing systematic screening for multi-morbidities in IRD patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systematic-screening-of-multimorbidities-results-in-an-increased-intake-of-comorbidity-preventive-medications-and-a-decreased-hospitalization-rate/