Background/Purpose: To determine the proportion of patients diagnosed with rheumatologic disease receiving preventive health care according to US Preventive Services Task Force recommendations with emphasis on hypertension, dyslipidemia, and glucose tolerance screening. Cardiovascular disease is the most prevalent co-morbidity for patients with Rheumatoid Arthritis, specifically ischemic cardiac disease. Studies have shown that more than half of premature deaths in people living with Rheumatoid Arthritis are attributable to cardiovascular disease. Studies also demonstrate a significantly increased risk of coronary artery disease in other inflammatory diseases including Systemic Lupus Erythematous, Gout, and Psoriatic Arthritis. Enhanced atherosclerosis in rheumatic disease is a result of higher rates of systemic inflammation. Despite the recognized risk of cardiovascular disease in rheumatologic disease, little is known about cardiovascular risk management in these patients.

Methods: Clinical data from June 2013 to November 2013 was abstracted from outpatient electronic medical records of patients seen in rheumatology clinic with primary care follow-up with one of the following International Classification of Diseases, Ninth Revision (ICD-9) codes: Rheumatoid Arthritis (714.0), Systemic Lupus Erythematous (710.0), Psoriatic Arthritis (696.0), and Gout (274.0). 69% had Rheumatoid Arthritis, 13% had Systemic Lupus Erythematous, 18% had Psoriatic Arthritis, and 13% had Gout, this included patients with more than one of the 4 ICD-9 codes. Charts were reviewed for blood pressure testing at the most recent primary care visit, a lipid profile within the last year, and glucose or Hemoglobin A1C testing within the last year. These probabilities were summarized and compared between disease categories using Pearson’s chi-square test.

Results: A total of 46 men and 121 women, with a mean age of 55.2 years, were identified. 79 were identified by having at least one of the four target ICD-9 codes. In this cohort, 100% were screened for hypertension, 24% for hyperlipidemia, and 27% for diabetes. Of the women, 100% were screened for hypertension, 24% for hyperlipidemia, and 29% for diabetes. There was no significant difference in screening between men and women. Rheumatoid Arthritis patients were more likely to be screened for diabetes, when compared to patients with Systemic Lupus Erythematous, Gout, or Psoriatic Arthritis (43% vs 12%, p < .05).

Conclusion: This data suggests that patients with rheumatologic diseases known to accelerate risk for cardiovascular disease are not being consistently screened in primary care settings. The data also suggests that physicians may be more aware of recommendations for cardiovascular screening in rheumatoid arthritis and less in other rheumatologic diseases. Although traditional cardiovascular risk factors may be suboptimal screening tools for patients with rheumatologic disease, studies must first identify gaps in existing screening and intervention. Further research is needed to develop cardiovascular screening guidelines and risk stratification models, as seen in diabetes, which are specific to rheumatologic disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-disease-prevention-in-rheumatologic-disease-assessing-screening-in-a-primary-care-setting/