title: Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.
abstract: 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.
authors.affiliation: 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. cehbarbe@ucalgary.ca.|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. cehbarbe@ucalgary.ca.
authors.forename: Claire E H
authors.initials: CE
authors.lastname: Barber
authors.affiliation: 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.
authors.forename: John M
authors.initials: JM
authors.lastname: Esdaile
authors.affiliation: 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.
authors.forename: Liam O
authors.initials: LO
authors.lastname: Martin
authors.affiliation: 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.
authors.forename: Peter
authors.initials: P
authors.lastname: Faris
authors.affiliation: 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.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.affiliation: 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.
authors.forename: Selynne
authors.initials: S
authors.lastname: Guo
authors.affiliation: 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.
authors.forename: Elena
authors.initials: E
authors.lastname: Lopatina
authors.affiliation: 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.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D019984:Quality Indicators, Health Care; D012306:Risk; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: CARDIOVASCULAR DISEASES; HEALTH CARE QUALITY INDICATORS; PRIMARY PREVENTION; RHEUMATOID ARTHRITIS