Background/Purpose: Comorbidities are increasingly recognized as significant contributors of reduced quality of life and increased mortality in RA. Cardiovascular diseases are the leading cause of premature death in RA. Previous research suggests that RA populations may receive sub-optimal care for their non-RA health related issues.

Our aim was to evaluate the quality of care for cardiovascular disease prevention in RA by measuring compliance with general population hyperlipidemia screening guidelines in RA compared to the general population.

Methods:  We conducted a retrospective matched cohort study among patients with RA who received care between Jan 1996 and Mar 2006 and followed-up until Dec 2010. RA cases were selected if they had ≥2 MD visits more than 2 mos apart with an RA code. Cases were excluded if they had ≥2 subsequent MD visits for other inflammatory arthritis; if they saw a rheumatologist and RA diagnosis was never confirmed; or if there were no subsequent RA diagnoses over a follow-up > 5 yrs (N=36,458). Controls were selected from the general population and matched 1:1 to RA cases on gender, age, and calendar year. Administrative data was obtained on all physician visits, hospital admissions, tests ordered and medications.

Outcome: Compliance with current screening guidelines for hyperlipidemia defined as testing for lipids at least once every 5 years for women ≥ 50 and men ≥ 40, excluding individuals with previous diabetes, coronary artery disease, or hyperlipidemia. Individuals’ follow-up was divided into 5-year eligibility windows, when they were eligible for the screening guideline. Each individual could contribute up to two five-year eligibility windows. Compliance was measured as the proportion of eligibility windows with at least one lipid test performed within the time period. Compliance rate between RA and controls, using eligibility windows as the unit of analysis, were compared via a GEE models to account for the lack of independence of observations obtained from the same patient, adjusting for age and gender. Compliance rate per patient was also calculated, by measuring the proportion of eligible windows per patient during follow-up when screening was performed. Mean compliance rates in the RA sample were compared to controls using a Mann-Whitney U test.

Results: We identified 13,117 individuals with RA (64.5% female, mean [SD] age 59.0 [11.3] years), contributing 5,273 five-year eligibility windows; and 14,694 controls (65.0% female, age 59.0 [11.4] years), contributing 7,228 five-year windows.  Overall, lipids were measured in 75.4% of the eligible time windows in the RA sample and in 76.7% for the control sample (OR[95% CI]=0.94 [ 0.86, 1.02], p=0.12). RA individuals met the recommended screening guidelines in 77.6% (SD= 37.5%) of their eligible time windows, compared to 78.5% (37.0%) for controls (p=0.22). 

Conclusion: In our population-based RA cohort, compliance with general population guidelines for diabetes and hyperlipidemia screening was similar in people with RA and the general population. However, given the increased prevalence and burden of cardiovascular disease, plasma glucose and lipid screening was sub-optimal for RA individuals.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-of-care-for-cardiovascular-disease-prevention-in-ra-compliance-lipid-screening-guidelines/