Low adherence to cardiovascular risk assessment guidelines in patients with rheumatoid arthritis: a retrospective chart review of routine clinical practice.

Abstract

Introduction: Patients with rheumatoid arthritis (RA) have an elevated risk of developing cardiovascular disease (CVD). Despite European guidelines recommending routine CVD risk assessment, implementation in clinical practice is challenging. The objectives of this review were to determine if patients attending an Irish tertiary rheumatology centre received CVD risk assessments in line with European guidelines and assess the extent of CVD risk factor screening over five years of routine rheumatology care.

Methods: A retrospective chart review was conducted for patients newly diagnosed with RA in 2018, with five-year follow-up. Data were extracted to determine if CVD risk assessments were performed, and where absent, risk was retrospectively calculated. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist for cohort studies was used to guide the reporting of this study.

Results: Among 21 patients, no documented CVD risk assessments were identified. CVD risk factor screening was consistently insufficient. There was a lack of documented clinical data necessary to conduct a CVD risk assessment on more than half of patients at study entry, and one quarter of patients at five-year follow up. Of those with data available (n = 10), retrospective calculations showed 80% had an undetected moderate or higher CVD risk at diagnosis. There was no documented referral to primary care for CVD risk assessment.

Conclusion: Implementation of CVD risk management guidelines in the routine care of patients with RA is challenging. The interpretation and operationalisation of guideline recommendations by rheumatology healthcare professionals in relation to implementation barriers needs to be explored.