Implementation of cardiovascular risk factor recording in a rheumatology outpatient clinic

Abstract

Background: The high cardiovascular (CV) risk in patients with rheumatoid arthritis (RA) is under-recognized and under-assessed in both primary and secondary health care. Our aim was to evaluate the quality of CV risk recording in rheumatology outpatient clinics and to evaluate strategies for optimizing CV risk factor screening in RA patients.

Methods: RA patients (n=1142) who visited the rheumatology outpatient clinic at the Hospital of Southern Norway in 2012, either attended the regular rheumatology outpatient clinic (RegROC), or an arthritis clinic (AC) that included a structured, systematic, interdisciplinary team-based model with annual CV assessments. Both patient groups had CV risk factors recorded in the patient medical journal, as well as in a computerized journal program, GoTreatIT-rheuma (GTI-r). We conducted thorough searches in both journals to ascertain how many patients had recorded CV risk factors.

Results: The AC patients had significantly more CV risk factors recorded compared to the RegROC patients (p-values <0.001). The relative risks for CV risk factors being recorded in the patient journals were 2.2-2.8 for various lipid values, 3.1 for brachial blood pressure and 3.3 for glucose. The discrepancies between AC and RegROC patients regarding CV risk factor recording were even more pronounced in the GTI-r journals, relative ratios being: 6.5 for lipid values, 8.4 for brachial BP and 10.2 for a complete CV risk profile.

Conclusion: We have shown that in RA patients attending a rheumatology outpatient clinic, an arthritis clinic approach with a systematic, team-based model of CV risk data collection is superior to CV risk data collection in a regular rheumatology outpatient clinic.