Implementation of the EULAR cardiovascular risk management guideline in patients with rheumatoid arthritis: results of a successful collaboration between primary and secondary care

Abstract

The updated European League Against Rheumatism (EULAR) guideline recommends cardiovascular disease (CVD) risk assessment at least once every 5 years in all patients with rheumatoid arthritis (RA). This viewpoint starts with a literature overview of studies that investigated the level of CVD risk factor (CVD-RF) screening in patients with RA in general practices or in outpatient clinics. These studies indicate that CVD-RF screening in patients with RA is marginally applied in clinical practice, in primary as well as secondary care. Therefore, the second part of this viewpoint describes an example of the successful implementation of the EULAR cardiovascular disease risk management (CVRM) guideline in patients with RA in a region in the south of the Netherlands where rheumatologists and general practitioners (GPs) closely collaborate to manage the cardiovascular risk of patients with RA. The different components of this collaboration and the responsibilities of respectively primary and secondary care professionals are described. Within this collaboration, lipid profile was used as an indicator to assess whether CVD-RF screening was performed in the previous 5 years. In 72% (n=454) of the 628 patients with RA, a lipid profile was determined in the previous 5 years. As part of routine quality control, a reminder was sent to the GP in case a patient with RA was not screened. After sending the reminder letter, in 88% of all patients with RA, CVD risk assessment was performed. This collaboration can be seen as good practice to provide care in line with the EULAR guideline.

Screening of Hyperlipidemia Among Patients With Rheumatoid Arthritis in the United States

“…In contrast, the European League Against Rheumatism (EULAR) recommendations for CVD risk management in inflammatory arthritis, and in particular in RA, have contributed to better management of CVD risk in patients with RA in some European countries . Whereas EULAR emphasizes that CVD risk is the rheumatologist's responsibility, our study, as well as others conducted in the US, showed that coordinated care between rheumatologists and non‐rheumatology practitioners increased the likelihood of primary lipid screening .…”

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

“…In both United States and Europe, patients with RA receive suboptimal care for their increased risk of CVD [15,17]. Members of the ATACC-RA group are presumably particularly motivated and interested in CVRM, and the majority of respondents had a system for CVRM in place and followed international guidelines for CVRM.…”

“…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].…”

“…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]. This variation in guideline adherence may be related to the different strategies used to implement CVRM in daily care.…”

FRI0625 Different strategies to implement the eular guideline for cardiovascular risk management in daily practice

“…1 A literature search indicates that this guideline is marginally applied in clinical practice. 2 An important factor explaining dissimilarities in the quality of CVRM could be the different strategies being used to implement this guideline in daily care.…”