Background/Purpose: There is an unmet need of implementing the knowledge of cardiovascular (CV) risk in patients with rheumatoid arthritis (RA) into clinical practice. Our aim was to evaluate CV risk factor (CVRF) recording in a rheumatology outpatient clinic (ROC), where the standard was annual CVRF recording for all patients. Moreover, we evaluated how various clinical models influenced the extent of CVRF recording, comparing a regular ROC (RegROC) to an arthritis clinic (AC), a structured, team-based model.

Methods: Of the 1142 RA patients visiting ROC at the Hospital of Southern Norway during 2012, 612 attended RegROC and 530 attended the AC. Allocation to either RegROC or the AC was based on clinical judgement by the rheumatologist and did not include any inclusion criteria. For all patients, CVRFs were to be recorded in the medical journal as well as in a computerized journal program, GoTreatIT-rheuma (GTI-r). We searched both journal systems to ascertain how many patients had CVRFs recorded.

Results: Overall, 38.2% of patients had CVRFs recorded and only 26.9% had recorded all the CVRFs included in the CV risk calculator, SCORE. When comparing the AC to the RegROC, odds ratios (OR) for CVRFs being recorded in the medical journal was for: lipids: 5.0-6.0, blood pressure (BP): 12.4, glucose: 9.1, and HbA1c: 6.1 (p for all < 0.001)(Table). In the GTI-r journal the discrepancies between the AC and RegROC were even more pronounced. OR for CVRFs being recorded was for lipids: 15.9, BP: 27.5 and for having recorded all the CVRFs included in SCORE: 21.0 (p for all < 0.001).

Conclusion: Despite high focus on CV disease, recording of CVRFs in the ROC was low; however it was augmented, but still not satisfactory in a structured, team-based model. There is necessity for improving systems for CVRF recording in patients with RA.

Table: Cardiovascular risk factors recorded in patients attending rheumatology consultations in a rheumatology outpatient clinic

*Adjusted for age and gender

ROC: rheumatology outpatient clinic, RegROC: Regular rheumatology outpatient clinic, AC: Arthritis clinic, CV: Cardiovascular, LDL: Low-density lipoprotein, HDL: High-density lipoprotein, BP: Blood pressure, HbA1c: Glycated haemoglobin, GTI-r: GoTreatIT-rheuma, Complete risk profile: Complete lipid values, smoking and blood pressure, CV medication: Anti-hypertensive and statins, CV co-morbidities: Hypertension, angina pectoris, acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, cerebrovascular accident, premature familiar cardiovascular disease