Lipid Testing in Patients with Rheumatoid Arthritis and Key Cardiovascular-Related Comorbidities: A Medicare Analysis

Abstract

Objective-For patients with rheumatoid arthritis (RA) and comorbid cardiovascular disease (CVD), diabetes, or hyperlipidemia, annual lipid testing is recommended to reduce morbidity and mortality from comorbidities. Given trends encouraging complex patients to receive care in "medical homes," we examined associations between regularly seeing a primary care provider (PCP) and lipid testing in RA patients with cardiovascular-related comorbidities. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Results-90% of patients had prevalent CVD, 46% had diabetes, and 64% had hyperlipidemia; however, annual lipid testing was only performed in 63% of these RA patients. Thirty percent of patients saw a PCP less than once per year, despite frequent visits (mean >9) with other providers. Patients without at least one annual PCP visit were 16% less likely to have lipid testing. Increased age, complexity scores, hospitalization, and large town residence predicted decreased lipid testing. NIH Public AccessConclusions-Despite comorbid CVD, diabetes, or hyperlipidemia, 30% of Medicare RA patients saw a PCP less than once per year, and one in three lacked annual lipid testing. Findings support advocating primary care visits at least once per year. Remaining gaps in lipid testing suggest the need for additional strategies to improve lipid testing in at-risk RA patients.

Impact of Rheumatoid Arthritis on Receiving a Diagnosis of Hypertension Among Patients With Regular Primary Care

“…In our longitudinal study, examining only incident hypertension cases, 64% of RA patients (compared to 49% without RA) with incident hypertension remained undiagnosed/untreated. Our results highlight that undiagnosed hypertension is a pervasive problem that is compounded for RA patients--suggesting gaps in current clinical care much like our previous work reporting low lipid testing in Medicare patients with RA (5, 6). …”

“…Based upon our prior work demonstrating low lipid testing in Medicare RA patients, (5, 6) we broadly hypothesized that RA patients, despite increased CVD risk, have not received as much CVD preventive care as non-RA peers. Specifically, in the present work we focus on hypertension, a prevalent and modifiable risk factor for increased CVD in both RA patients and the general population.…”

Cardiovascular Disease and Rheumatoid Arthritis: An Update

“…Toms et al studied a cohort of RA patients without established CVD or diabetes and found that in the high risk group, 2-26% (depending on risk stratification group), had sufficiently high risk to require statin therapy, although the majority of them (58-95%) were not treated (16). Bartels and colleagues studied RA patients enrolled in Medicare who were older than age 65 and had both RA and concomitant CVD (90%), diabetes (46%), or hyperlipidemia (64%) (17). In this high risk cohort with CVD, 30% of the RA patients studied saw a PCP less than once per year and 1 in 3 lacked annual cholesterol screening (17).…”

“…Bartels and colleagues studied RA patients enrolled in Medicare who were older than age 65 and had both RA and concomitant CVD (90%), diabetes (46%), or hyperlipidemia (64%) (17). In this high risk cohort with CVD, 30% of the RA patients studied saw a PCP less than once per year and 1 in 3 lacked annual cholesterol screening (17). Finally, Lindhardsen et al reported a marked discrepancy in secondary prevention in RA patients discharged from the hospital after suffering a first myocardial infarction (MI).…”

Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice

“…The CVD risk imposed by RA is both under-recognised and underassessed in primary care 5 6. Furthermore, a recent study reported that 30% of RA patients with comorbid CVD, diabetes or hyperlipidaemia consult a primary care physician (PCP) less than once a year, despite frequent visits to other providers such as rheumatologists 5…”