Background/Purpose: Systematic screening for multimorbidities has been carried out since 2014 at Montpellier University Hospital in patients with chronic inflammatory rheumatism (IRD). The aim of this work was to evaluate the impact of this screening on patient management and hospitalization rates during a 3-year follow-up.

Methods: IRD patients benefiting from the screening program (index date) were identified in the French national health database SNDS and matched to 3 controls on age, sex, IRD and disease duration. The primary endpoint was a composite score assessing the dispensing of comorbidity-preventing drugs (vaccines, anti-platelet treatments, lipid-lowering drugs, anti-osteoporotic drugs) in the year following the index date. Secondary endpoints were cardiologist/pneumologist consultation, all-cause hospitalization rate, hospitalization for fractures, cardiovascular events or infections. Odds ratios (IC95%) were calculated, with multivariate logistic regression adjusted for medical history (hypertension, diabetes, heart failure, CV disease, lung disease, osteoporotic fractures) and medications related to IRD or included in the primary endpoint in the previous year.

Results: 441 patients who had participated in the screening program (exposed) were identified in the national database and matched with 1323 unscreened patients (controls). Of these, 73.9% suffered from rheumatoid arthritis, 18.1% from ankylosing spondylitis and 7.9% from psoriatic arthritis. Exposed patients had significantly less diabetes than controls (4.5 vs. 7.6%) and received significantly less glucocorticoids (36.5 vs. 42.1%), more csDMARDs (56.9 vs. 42.8%) and more bDMARDs (57.4 vs. 32.6%) than controls. The use of drugs evaluated in the primary criteria was more frequent in the year prior to inclusion in the exposed group than in controls (58.4 vs. 45.3%). Exposed patients met the primary endpoint almost twice as often as controls (OR=1.9 [1.5-2.4]). The initiation of preventive medication for comorbidity remained significantly more frequent after adjustment for medical history and previous medication (OR=1.5 [1.1-2.1]). After adjustment for baseline comorbidities, exposed patients consulted significantly more cardiologists or pulmonologists in the year following screening than controls (OR=1.6 [1.2-2.1]). Controls had a three-fold higher risk of all-cause hospitalization (3.1 [2.1-4.6]) at one-year follow-up, which remained significant after adjustment (2.4 [1.5-4.0]). Controls had a significantly higher risk of hospitalization for cardiovascular events (2.1 vs. 0.3%), infections (6.8 vs. 3.6%) and emergency room admissions (20.3 vs. 10.6%) than controls at 2-year follow-up.

Conclusion: The recommendations given during the comorbidity screening program were applied, with an increase in the use of preventive medication for comorbidities and more consultations with specialists. After adjusting for comorbidities and medications at baseline, we observed a decrease in the risk of hospitalization rates, which may reflect the positive impact of carrying out systematic screening for multi-morbidities in IRD patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systematic-screening-for-multimorbidities-leads-to-an-increased-use-of-comorbidity-preventing-medications-and-lower-hospitalization-rates/