Background/Purpose:

Cardiovascular (CV) disease is a major cause of morbidity and mortality in the rheumatoid arthritis (RA) population. Thus, the recognition and management of cardiovascular risk factors in patients with RA is especially important. Despite increased awareness of this risk, recent data suggests that adherence to both primary and secondary prevention strategies is low in the RA population compared to other high risk groups (e.g. diabetics). The objective of this study was to assess rheumatologists’ perceptions of screening for and treating hyperlipidemia (HLD) and CV risk factors in patients with RA to inform the development of quality improvement initiatives.

Methods:

In this qualitative study, all University of Pennsylvania rheumatologists were contacted with an email link to an online survey. The survey, administered via REDCap, included 15 questions assessing attitudes towards lipid screening and CV risk in RA. Answers were deindentified. The chi-squared test was used to examine the association between respondent characteristics and attitudes.

Results:

Of 28 survey invitations, 24 (85.7%) were returned. All respondents felt there was either a high (N=14) or moderate (N=10) risk of CV disease in RA. Rheumatologists’ perceptions of their practice are given in the Table. Seventeen (70.8%) respondents did not believe that primary care physicians (PCPs) are aware of the increased CV risk in RA. Eighteen (75%) believed that both rheumatologists and PCPs should screen for HLD in patients with RA; the remainder felt that PCPs are responsible. Female physicians were more likely to report that both rheumatologists and PCPs should be responsible for screening for HLD (p= 0.03). Nearly all respondents (87.5%) felt that PCPs should be responsible for treating HLD. When asked to rank the clinically most useful approach to estimating CV risk in RA among 3 options, 17 of 21 respondents ranked “CAD equivalent like diabetes mellitus” as their first choice. The most commonly mentioned barriers to screening were time (N=11), patient complexity (N=6), and forgetting or needing a prompt (N=4). An electronic health record (EHR) reminder was the most commonly mentioned idea for increasing HLD screening in rheumatology and primary care practices (N=11).

Conclusion:

All respondents believed that there is at least a moderately increased risk of CV disease in RA. Most believed that PCPs are not aware of the increased risk, but the majority also believed that PCPs should be responsible for treating HLD. Quality improvement strategies to bridge this disconnect are needed. Several barriers to screening were identified. Respondents recommended using an EHR prompt to increase screening for HLD and improve recognition of CV risk.

Table. Rheumatologists’ Perceptions of Their Own Practice

Question	Total Respondents – n (%)
Do you routinely check lipids in your patients with RA?
Never	1 (4.2)
Almost Never	5  (20.8)
Sometimes	8 (33.3)
Most of the Time	9 (37.5)
Always	1 (4.2)
Do you routinely initiate treatment of hyperlipidemia in your patients with RA?
Never	4 (16.7)
Almost Never	11 (45.8)
Sometimes	8 (33.3)
Most of the Time	1 (4.2)
Always	0
Do you regularly counsel your RA patients about the increased risk for cardiovascular disease?
Never	1 (4.2)
Almost Never	1 (4.2)
Sometimes	6 (25.0)
Most of the Time	12 (50.0)
Always	4 (16.7)
How comfortable do you feel in counseling about diet and exercise in your patients with RA and hyperlipidemia?
Not at all comfortable	1 (4.2)
Somewhat comfortable	6 (25.0)
Very comfortable	17 (70.8)
How comfortable do you feel initiating medication therapy for hyperlipidemia?
Not at all comfortable	2 (8.3)
Somewhat comfortable	12 (50.0)
Very comfortable	10 (41.7)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatologists-attitudes-on-cardiovascular-risk-and-lipid-screening-in-patients-with-rheumatoid-arthritis-at-an-academic-medical-center/