Barber Claire E H, Esdaile John M, Martin Liam O, Faris Peter, Barnabe Cheryl, Guo Selynne, Lopatina Elena, Marshall Deborah A
From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.
C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary.
J Rheumatol. 2016 Nov;43(11):1965-1973. doi: 10.3899/jrheum.160241. Epub 2016 Aug 1.
Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice.
Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate.
There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively).
Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.
心血管疾病（CVD）是类风湿关节炎（RA）患者的主要合并症。本研究旨在确定11项最近开发的针对RA的CVD质量指标（QI）在临床实践中的表现。
回顾性审查在1个中心随访的RA患者（早期疾病或接受生物制剂治疗）的病历。完成了对2年内11项QI依从性的系统评估。QI的表现以通过率百分比报告。
共审查了170份病历（107例早期疾病患者和63例接受生物制剂治疗的患者）。诊断时（早期疾病）和开始使用生物制剂时（接受生物制剂治疗）最常见的CVD危险因素包括高血压（26%）、肥胖（25%）、吸烟（21%）和血脂异常（15%）。CVD QI的表现差异很大。表现较差的领域（通过率<10%）包括正式CVD风险评估的记录、向初级保健医生（PCP）传达RA患者CVD风险增加的信息、体重指数记录以及超重时的咨询、向PCP传达血压升高的信息，以及讨论CVD风险患者使用抗炎药的风险和益处。糖尿病筛查率和血脂筛查率分别为67%和69%。在逐渐减少皮质类固醇使用意图的记录方面表现最佳（第1年和第2年分别为98%-100%）。
发现了CVD风险管理方面的差距，突出了质量改进的必要性。改进的关键目标包括风湿病学和初级保健之间CVD护理的协调，以及传达RA中增加的CVD风险。
