Background/Purpose:

There is a recognised increase in the incidence of heart disease in patients with rheumatoid arthritis (RA)

Surveys of usual practice however frequently show a significant gap in the management of cardiovascular (CV) risk factors¹.

This study was undertaken with the aim of reviewing our experience and if a management gap was found, to see if this could be effectively and efficiently addressed by a nurse led initiative

AIM

To identify the extent of awareness and management of CV risk factors in patients with RA attending a general rheumatology clinic

To explore the feasibility of a nurse led assessment programme and evaluate its effectiveness in managing CV risk

Methods:

The medical records of all patients with RA were audited at the time of their scheduled review visit for the extent of CV risk assessment that had been completed and recorded by the treating rheumatologist in the previous 12 months.

Patients were then asked about their knowledge of CV risk and about assessments that had been undertaken through their family physician

A standard letter highlighting the increase in CV risk in RA together with the patient’s CV risk factor assessment was then sent to the family physician, with recommendation to address any apparent  deficiencies

Patients were seen again 6 months later and the completeness and effectiveness of CV risk management reviewed

Results:

Patient awareness of the increased CV risk in RA was only 19%

Initial review showed that in the prior 12 months 86% of patients had had a blood pressure (BP) check;  31% had adequate serum lipid and 39% had glucose/HbA1c measurement;  42% had their weight and height recorded and 75% of smokers had received counselling

At the 6 month review of the first 150 patients all patients had had their BP checked.  79 (53%)were on active treatment.  17 had their treatment changed and 1 was newly started

Comprehensive assessment of lipids rose from 31% of patients to 60%; and for glucose/Hba1c  from 39% to 62% . Two patients had treatment changes and one was newly started

Counselling of the 30 patients who smoked and the 103 with abnormal body mass index (BMI) resulted in 2 patients quitting smoking.  59 (39%) showed an improved BMI with 2 returning to ideal body weight

Average time per patient encounter was 26 mins at an estimated cost, excluding laboratory costs, of $21.03 AUS per patient encounter

Conclusion:

1 A significant gap in the routine management of CV risk factors was identified

2 Patient awareness of the increased risk of CV disease in RA is low

3 A nurse led intervention programme is feasible and effective in addressing the problems of CV risk factor management in patients with RA, but needs to be adequately resourced

Reference   1  Webster R J et al.  MJA 2009; 191: 324-329

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