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Abstract Number: 1861

Lipid Screening in Medicare Beneficiaries with Rheumatoid Arthritis

Nikila Kumar1, Wei-Hsuan Lo-Ciganic2, Lili Zhou3,4, Erin L. Ashbeck4 and C. Kent Kwoh1,4, 1Division of Rheumatology, Department of Medicine, The University of Arizona, Tucson, AZ, 2Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, TUCSON, AZ, 3College of Pharmacy, University of Arizona, Tucson, AZ, 4University of Arizona Arthritis Center, Tucson, AZ

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, Cholesterol, Lipids, rheumatoid arthritis (RA) and risk assessment

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Session Information

Date: Monday, October 22, 2018

Title: 4M086 ACR Abstract: RA–DX, Manifestations, & Outcomes II: DX & Prognosis I (1858–1863)

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Patients with RA have an increased risk of cardiovascular disease (CVD) accounting for over 50% of premature deaths in the RA population. EULAR recommends repeat assessment of CVD risk every 5 years or when major changes in DMARD therapies are instituted. Lipid screening should be performed to evaluate and mitigate CVD risk. Our objective was to estimate the 5-year lipid screening rate among Medicare beneficiaries with RA based on the specialties of their treating providers, including rheumatology, primary care providers (PCP) and cardiology.

Methods: We conducted a retrospective cohort study using 2011-2015 Medicare claims data (5% representative sample) that included fee-for-service beneficiaries with RA who were continuously enrolled in Parts A and B for 5 years and had at least 1 outpatient visit during continuous enrollment. Lipid screening including non-fasting total cholesterol and high-density lipoprotein (HDL) was ascertained using CPT codes. We estimated the proportion of beneficiaries receiving at least one lipid screening during the 5 years, using logistic regression, based on the specialties of their treating providers. We stratified the analysis by those with and without preexisting CVD or CVD-risk conditions (e.g., hyperlipidemia, hypertension, and diabetes mellitus).

Results: Among 40,120 beneficiaries with RA, 35,330 (88%) had preexisting CVD or CVD-risk conditions. RA patients without preexisting conditions had a 5-year lipid screening rate of 52.8% (95%CI: 51.4, 54.2), while those with preexisting conditions had a screening rate of 71.2% (95%CI: 70.8, 71.7). RA patients without preexisting conditions who only saw a rheumatologist had a lower 5-year lipid screening rate (21.6%, 95%CI: 14.6, 30.9), compared to patients who saw a PCP only (54.4%, 95%CI: 50.5, 58.3) or a cardiologist only (40.0%, 95%CI: 15.8, 70.3). RA patients with preexisting conditions who only saw a rheumatologist had a screening rate of 35.2% (95%CI: 26.7, 44.8), whereas patients who only saw a PCP or cardiologist had screening rates of 71.3% (95%CI: 69.7, 72.8) and 77.3% (95%CI: 65.7, 85.8), respectively. Screening rate estimates for combinations of physician specialties suggest that beneficiaries seen by a PCP and/or a cardiologist have higher rates of lipid screening, with little influence from rheumatology care (Table 1).

Conclusion: Five-year lipid screening rates among Medicare beneficiaries with RA did not meet EULAR recommendations, particularly among those without preexisting CVD or CVD-risk conditions. Patients that were seen by only a rheumatologist had the lowest rate of screening, when compared to patients seen by a PCP or a cardiologist. Rheumatologists need to devise screening implementation strategies to improve comprehensive coordinated CVD preventative care.

Kumar%20Table1.png


Disclosure: N. Kumar, None; W. H. Lo-Ciganic, None; L. Zhou, None; E. L. Ashbeck, None; C. K. Kwoh, None.

To cite this abstract in AMA style:

Kumar N, Lo-Ciganic WH, Zhou L, Ashbeck EL, Kwoh CK. Lipid Screening in Medicare Beneficiaries with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/lipid-screening-in-medicare-beneficiaries-with-rheumatoid-arthritis/. Accessed .
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