Background/Purpose: Cardiovascular disease is one of the leading causes of death in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients. Its risk in RA and SLE is comparable to that of diabetes. Observational studies show that RA patients frequently have unidentified and untreated risk factors due to gaps in screening. There are currently no guidelines in the United States on cardiovascular risk reduction for patients with autoimmune diseases. EULAR guidelines have suggested multiplying 10-year ACC/AHA atherosclerotic cardiovascular disease (ASCVD) risk scores by 1.5. A 2015 study by Ozen et al. found that screening for 10-year ASCVD risk scores of >5% led to increased detection of subclinical atherosclerosis. Our aim is to increase the rate of annual lipid screening in RA and SLE patients at our resident clinic. We also aim to increase the use of statin therapy in patients with 10-year ASCVD risk scores ≥5%.

Methods: Baseline data was established by reviewing electronic medical records (EMRs) of patients with SLE and RA in the internal medicine resident clinic. Two plan-do-study-act (PDSA) cycles were performed over a four-month period. First, we developed a custom EMR note template for the resident rheumatology clinic that prompted residents to review lipid screening, calculate 10-year ASCVD risk score, determine if patients were on appropriate statin therapy, and notify the patient’s primary care provider as needed. We also provided resident education on ASCVD risk assessment and utilization of note template. Second, we adjusted the note template to prompt residents to notify clinic staff to schedule an office visit for cardiovascular risk assessment if indicated and provided additional resident education.

Results: We reviewed 79 patients in the pre-intervention period (73.4% RA, 20.3% SLE, 6.3% SLE and RA). Ninety-two percent of patients were ≥ 40 years old, 82% were female, and 41% had comorbid conditions of diabetes mellitus, coronary artery disease, or cerebrovascular accident.  After PDSA cycle 2, 88 patients with similar baseline characteristics were reviewed. Rates of documented lipid screening (92.4% vs 93.2%, p = 0.846) and annual lipid screening (62.0% vs 60.2%, p = 0.812) did not show improvement. The proportion of patients with 10-year ASCVD risk scores ≥ 5% on statin therapy in the current population (33.3% vs 57.9%, p = 0.038) showed improvement; a subgroup analysis of the original 79 patients (33.3% vs 58.3%, p = 0.038) also showed improvement.

Conclusion: In our clinic, there was a statistically significant increase in the proportion of patients on statin therapy with 10-year ASCVD risk scores ≥5% in the current and baseline populations. The rate of yearly lipid screening remained unchanged despite the use of a custom EMR template. Future PDSA cycles will focus on improving the rate of annual lipid screening.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-cardiovascular-risk-assessment-in-patients-with-rheumatoid-arthritis-and-systemic-lupus-erythematosus-in-an-internal-medicine-resident-clinic-a-quality-improvement-initiative/