In an effort to improve the prevention of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA), one researcher is taking a close look at communication between RA patients, primary care physicians, and rheumatologists.
Previous research has shown that RA patients are at a 60% greater risk of CVD events, including death, and that despite more clinic visits, RA patients have lower rates of preventive screenings, such as cholesterol tests, compared to general medical patients.
Christie Bartels, MD, MS, assistant professor of medicine, rheumatology, at the University of Wisconsin School of Medicine and Public Health in Madison, hopes that her ongoing research will result in more proactive partnerships between rheumatologists and primary care physicians to help RA patients modify their risk factors, and ultimately prevent CVD.
“My research aims to address how we can manage the heart-disease risk factors that are modifiable, like blood pressure and cholesterol count, to help RA patients receive the survival gains that the general population has seen in the last decades,” says Dr. Bartels, who received a Bridge Funding Award from the Rheumatology Research Foundation to help fund her research.
The Bridge Funding Award allowed Dr. Bartels to adequately prepare for her three-year-long study while waiting on funding from a scored National Institutes of Health–National Institute of Arthritis and Musculoskeletal Diseases K23 grant. She presented results from the first year of her research at a recent ACR meeting.
Using a data set of local patients receiving regular care in a large health system, Dr. Bartels studied patients who had not yet been diagnosed with hypertension despite high blood pressure readings.
“I tested the hypothesis that RA patients would be less likely to get a diagnosis, or it would take longer for them to be diagnosed,” Dr. Bartels says. “We found that was true, and despite frequent visits to their clinicians, RA patients were almost 30% less likely to get a new hypertension diagnosis.”
In earlier work, Dr. Bartels found that patients who regularly visited a primary care physician were slightly more likely to get lipid testing than those who saw a rheumatologist only, but they were still less likely than the average Medicare patient to get tested.
“So it seemed that seeing a primary care physician alone might not be adequate and we might need active partnerships between rheumatologists and primary care physicians to deliver the high level of care that is needed for this population,” she says.
“I’m hopeful we’ll be able to inform rheumatologists about what roles are appropriate and help them develop a patient-centered approach to helping patients modify their CVD risk factors, whether that be [by] empowering primary care physicians with knowledge and having them manage these risks, or [having] the rheumatologists themselves actively engage in helping modify risks,” Dr. Bartels adds.
Determining the interventions that will help RA patients manage and modify CVD risk is the next step in Dr. Bartels’ research. She’s currently conducting an examination of RA visit notes and clinical data. Her plan is to couple that information with interviews of primary care physicians, rheumatologists, and patients to determine how engaged each group is in conversations around CVD risk and how patients envision optimal input from their treatment providers.
“We’ll be able to describe the relative impact of those different roles and patient preferences so that we can better partner with our patients to help them understand and manage their modifiable heart disease risks,” Dr. Bartels says.
For more information about the Bridge Funding Award and other Rheumatology Research Foundation awards and grants programs, visit www.rheumatology.org/Foundation or contact Damian Smalls at (404) 633-3777, or [email protected].
Funding for this award was made possible in part through the financial support of the Arthritis Foundation.