Patients with rheumatoid arthritis had low rates of screening for primary hyperlipidemia, but patients who visited both a rheumatologist and a nonrheumatology clinician for follow-up were more likely to be screened, according to research published in Arthritis Care & Research.
American Heart Association
Iris Navarro-Millán, MD, MSPH, from Cornell University, New York, and her colleagues performed a retrospective study of roughly 244,000 participants with private insurance, Medicare, or Medicaid who had rheumatoid arthritis (13,000 patients), diabetes (63,000), both rheumatoid arthritis (RA) and diabetes (1,000), and neither RA nor diabetes (168,000) during 2006-2010. Patients were between the ages of 41 years and 85 years. There were similar rates of hypertension among the RA patients (40%) and patients with neither RA nor diabetes (39%), as well as among the diabetes patients (79%) and the both patients with both RA and diabetes (70%).
The researchers found 37% of RA patients, 60% of diabetes patients, 55% of patients with both RA and diabetes, and 41% of patients with neither RA nor diabetes received primary lipid screening over 2 years’ follow-up. For RA-only patients, 22% saw a rheumatologist only, while 56% saw both a rheumatologist and then a nonrheumatology clinician at 2-years’ follow-up. Patients who visited a rheumatologist and a nonrheumatology clinician for follow-up were 55% more likely to receive primary lipid screening, and RA patients who visited a nonrheumatology clinician only were 22% more likely to receive screening than RA patients who saw only a rheumatologist.
Dr. Navarro-Millán and her colleagues said European RA patients may be more likely to receive screening for hyperlipidemia because their health care systems follow European League Against Rheumatism (EULAR) recommendations for management of cardiovascular disease (CVD) risk, while many rheumatologists based in the United States are “still reluctant to take responsibility to assess and mitigate (if needed) CVD risk for patients with RA.”
“Measures to achieve this goal must be implemented and may include defining specific roles for rheumatologists, nonrheumatology practitioners, and patients to determine who should be responsible for hyperlipidemia screening and treatment for patients with RA,” Dr. Navarro-Millán and her colleagues wrote.
Limitations to the study include lack of information on uninsured patients, lack of some clinical and demographic data, and potential misclassification of some clinicians who may have provided rheumatology-specific care but may have been in primary care settings.
This study is funded by grants and contracts from the National Institutes of Health and the Department of Health and Human Services. The authors report no relevant financial disclosures.
SOURCE: Navarro-Millán I et al. Arthritis Care Res. 2018. doi: 10.1002/acr.23810.