Cardiovascular risk management in rheumatoid arthritis: A large gap to close

Ladak, Karim; Hashim, Jomana; Clifford-Rashotte, Matthew; Tandon, Vikas; Matsos, Mark; Patel, Ameen

doi:10.1002/msc.1196

Cited by 18 publications

(24 citation statements)

References 20 publications

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“…However, the time constraints of a busy office practice often preclude making CVD risk stratification a routine part of RA patient care. Indeed, 79% of rheumatologists cite a lack of time as a major barrier [3]. Even so, rheumatologists are well positioned to help manage CVD risk in RA patients because 30% of CVD risk in RA patients is attributable to systemic inflammation and other RA-related factors [4,5].…”

Section: Introductionmentioning

confidence: 99%

Derivation and internal validation of a multi-biomarker-based cardiovascular disease risk prediction score for rheumatoid arthritis patients

et al. 2020

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Background Rheumatoid arthritis (RA) patients have increased risk for cardiovascular disease (CVD). Accurate CVD risk prediction could improve care for RA patients. Our goal is to develop and validate a biomarker-based model for predicting CVD risk in RA patients. Methods Medicare claims data were linked to multi-biomarker disease activity (MBDA) test results to create an RA patient cohort with age ≥ 40 years that was split 2:1 for training and internal validation. Clinical and RA-related variables, MBDA score, and its 12 biomarkers were evaluated as predictors of a composite CVD outcome: myocardial infarction (MI), stroke, or fatal CVD within 3 years. Model building used Cox proportional hazard regression with backward elimination. The final MBDA-based CVD risk score was internally validated and compared to four clinical CVD risk prediction models. Results 30,751 RA patients (904 CVD events) were analyzed. Covariates in the final MBDA-based CVD risk score were age, diabetes, hypertension, tobacco use, history of CVD (excluding MI/stroke), MBDA score, leptin, MMP-3 and TNF-R1. In internal validation, the MBDA-based CVD risk score was a strong predictor of 3-year risk for a CVD event, with hazard ratio (95% CI) of 2.89 (2.46–3.41). The predicted 3-year CVD risk was low for 9.4% of patients, borderline for 10.2%, intermediate for 52.2%, and high for 28.2%. Model fit was good, with mean predicted versus observed 3-year CVD risks of 4.5% versus 4.4%. The MBDA-based CVD risk score significantly improved risk discrimination by the likelihood ratio test, compared to four clinical models. The risk score also improved prediction, reclassifying 42% of patients versus the simplest clinical model (age + sex), with a net reclassification index (NRI) (95% CI) of 0.19 (0.10–0.27); and 28% of patients versus the most comprehensive clinical model (age + sex + diabetes + hypertension + tobacco use + history of CVD + CRP), with an NRI of 0.07 (0.001–0.13). C-index was 0.715 versus 0.661 to 0.696 for the four clinical models. Conclusion A prognostic score has been developed to predict 3-year CVD risk for RA patients by using clinical data, three serum biomarkers and the MBDA score. In internal validation, it had good accuracy and outperformed clinical models with and without CRP. The MBDA-based CVD risk prediction score may improve RA patient care by offering a risk stratification tool that incorporates the effect of RA inflammation.

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Section: Introductionmentioning

confidence: 99%

Derivation and internal validation of a multi-biomarker-based cardiovascular disease risk prediction score for rheumatoid arthritis patients

et al. 2020

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“…They are mainly written to make the rapidly growing (scientific) information flow manageable; to reduce variation in actions between healthcare providers; to base clinical actions more on scientific evidence and to work more transparently [13]. However, a literature search indicates that CVRM guidelines as well as guidelines in general are not applied effectively in routine clinical practices [14][15][16]. Percentages of patients with RA of whom CVD-RFs are identified vary between 24.9 and 88% [15,17].…”

Section: Introductionmentioning

confidence: 99%

Strategies for implementation of guideline recommended cardiovascular risk management for patients with rheumatoid arthritis: results from a questionnaire survey of expert rheumatology centers

et al. 2020

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The aim was to study the different strategies used to implement cardiovascular risk evaluation and management for patients with rheumatoid arthritis (RA) in daily clinical practice. A questionnaire survey was performed among both the members of the international TransAtlantic Cardiovascular Risk Consortium for Rheumatoid Arthritis (ATACC-RA) as well as the Survey of cardiovascular disease risk factors (CVD-RF) in patients with RA (SURF-RA) group. The questionnaire included 18 questions with the overarching topics: (1) organization and responsibility of cardiovascular risk management (CVRM); (2) screening of CVD-RFs; (3) overview current CVRM status; and (4) availability of data regarding CVRM. Based on the answers, two researchers (JW, PR) independently categorized the different strategies. Thirteen out of 27 rheumatology centers responded to the questionnaire. One rheumatology center did not have organized CVRM for their RA patients. Among the other centers, three strategies to organize CVRM in daily practice were distinguished: (1) the rheumatologist performs CVRM during outpatient visits (n = 6); (2) cardiologists and rheumatologists cooperate in a cardio-rheuma-clinic/team with different tasks and responsibilities (n = 3); and (3) the general practitioner screens and intervenes on CVD-RFs (n = 3). Each CVRM strategy was based on agreements between medical professionals and was also dependent on the national healthcare system and available financial resources. Three strategies were identified for CVRM implementation in daily clinical practice based on who is primarily responsible for performing CVRM. More research is warranted to compare their relative merits and effectiveness in relation to CVRM.

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“…1 Sixty-three percent of rheumatologists do not manage CVD risk in their patients with RA: 82% because they feel this should be addressed by the PCP, and 79% due to lack of time. 2 One hundred percent of rheumatologists believe managing CVD risk is a priority in this population. 2 The increased risk of CVD morbidity and mortality in patients with RA is supported by evidence, citing up to a 2-fold increase compared with the general population.…”

Section: Introductionmentioning

confidence: 99%

“…2 One hundred percent of rheumatologists believe managing CVD risk is a priority in this population. 2 The increased risk of CVD morbidity and mortality in patients with RA is supported by evidence, citing up to a 2-fold increase compared with the general population. [3][4][5][6] CVD events occur approximately 1 decade earlier in patients with RA than in the general population.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Health in Patients With Rheumatoid Arthritis

McMahon¹,

Ware²

2020

The Journal for Nurse Practitioners

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Cardiovascular risk management in rheumatoid arthritis: A large gap to close

Abstract: There is marked underdiagnosis and undertreatment of cardiac risk in RA. Several major barriers exist, including lack of time. Most rheumatologists feel that this aspect of care is the responsibility of primary care physicians.

Cited by 18 publications

References 20 publications

Derivation and internal validation of a multi-biomarker-based cardiovascular disease risk prediction score for rheumatoid arthritis patients

Derivation and internal validation of a multi-biomarker-based cardiovascular disease risk prediction score for rheumatoid arthritis patients

Strategies for implementation of guideline recommended cardiovascular risk management for patients with rheumatoid arthritis: results from a questionnaire survey of expert rheumatology centers

Cardiovascular Health in Patients With Rheumatoid Arthritis

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