FRI0738-HPR Nurse-led screening: changes in cardiovascular risk profile and association to socio-economic status in outpatients with inflammatory arthritis

Abstract

Background:Persons with inflammatory arthritis have an increased risk for cardio-vascular (CV) disease and screening is therefore recommended (1)Objectives:To investigate changes in the patient’s risk for CV disease and whether risk reduction was associated with socio-economic status in a hospital population of outpatients with inflammatory arthritis (IA) (rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS))Methods:Outpatients with IA ≤85 years of age connected to King Christian X’s Hospital for Rheumatic Diseases in Graasten, Denmark, who had participated in a 30-minute nurse-led screening consultation (SC) (2) based on the EULAR recommendations between July 2012 and July 2015 were included. During the SC the patients’ risk for cardiovascular death was calculated according to the SCORE system (3). Elements of motivational interviewing were used. Data was entered in a national rheumatology quality database, DANBIO, and combined with national registers. Whether socio-economic status influenced changes in risk factors from first to second screening consultation was explored in simple logistic regression analyses for each risk factor including the socio-economic variables sex, age, marital status, education, and income separately one at a timeResults:A total of 1266 patients, 18–85 years of age, were included; 72.5% with RA and 27.5% with AS or PsA. 447 patients had high risk (≥5% risk) for CV death in 10 years and 819 had low to moderate risk (<5%). Number of patients achieving relevant changes from the first to the subsequent yearly or biannual screening consultation, are reported for high and low risk patients in table 1.For all the patients, female gender significantly decreased the odds for increased exercise frequency (OR, [CI], p-value) (0.40[0.17; 0.92], 0.0320), being single decreased the odds of reduced BMI (0.57[0.32; 0.99, 0.0472] and age ≥65 years increased the odds of a normalization of SBP (2.13[1.30; 3.50], 0.0027). In high risk patients, higher education (1.94[1.05; 3.57], 0.0338) and higher income (2.07[1.00; 4.28], 0.0508) increased the odds off a normalization of SBP although not significant, we include this effect based on the confidence interval not including any values indicating a decreased oddsTable 1Changes in CV risk profile from first to subsequent screening consultation for high and low risk patientsConclusions:Clinically relevant reductions in CV risk factors were seen after SC for CV risk in both high and low risk patients. Surprisingly female patients improved their exercise habits less often than male patients did. Older age increased the odds to reach a normal SBP. In high-risk patients, education and income positively influenced the odds to reduce SBP to normalReferences1. Agca R, et al. Ann Rheum Dis. 2017Jan;76(1):17–28.2. Primdahl J, et al. Ann Rheum Dis2013; 72(10):1771–1776.3. Conroy R, et al. 2003;24(11):987–1003.Disclosure of Interest:None declared

Patients’ perspectives on adherence to cardiovascular screening consultation and lifestyle changes

“…Similar statements were found in this study, where the participants described improvement in their overall well-being following an increase in physical activity. A previous study explored changes between the first and second screening in patients with inflammatory arthritis [ 35 ]. The study found that 18% of the patients at high risk and 20% of the patients at low risk increased their physical activity from <5 to ≥5 times a week [ 35 ].…”

“…A previous study explored changes between the first and second screening in patients with inflammatory arthritis [ 35 ]. The study found that 18% of the patients at high risk and 20% of the patients at low risk increased their physical activity from <5 to ≥5 times a week [ 35 ]. The study also explored changes in smoking habits and found that 20% of high-risk patients and 15% of low-risk patients, who had reported being smokers at the initial screening, had transitioned to non-smokers by the second screening [ 35 ].…”

“…The study found that 18% of the patients at high risk and 20% of the patients at low risk increased their physical activity from <5 to ≥5 times a week [ 35 ]. The study also explored changes in smoking habits and found that 20% of high-risk patients and 15% of low-risk patients, who had reported being smokers at the initial screening, had transitioned to non-smokers by the second screening [ 35 ]. These results indicate that the increased awareness and knowledge of the consequences of the habits, as stated by the participants in this study, can contribute to positive changes in lifestyle.…”