May 31, 2018
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More than 70% of RA clinic visits lack discussion of cardiovascular risk

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Despite the elevated risk for cardiovascular disease associated with rheumatoid arthritis, and regardless of their blood pressure levels, most patients with rheumatoid arthritis did not receive any documented communication regarding blood pressure, according to findings published in the Journal of Clinical Rheumatology.

“Patients with RA and other rheumatic conditions have higher risk for early cardiovascular disease (CVD) than peers, and hypertension is the leading modifiable factor to reduce that risk, so we wanted to see how rheumatology clinics were doing at addressing high blood pressures,” Christie Michels Bartels, MD, MS, of the University of Wisconsin School of Medicine, division of rheumatology, told Healio Rheumatology. “Unfortunately, we found that even when rheumatology clinics recorded severely high blood pressures of 160/100 or higher, rheumatologists failed to discuss it in 2 out of 3 visit notes. They also only recommended blood pressure follow up in 1 in 10 visits.”

Bartels and colleagues also noted that rheumatology clinics, where patients with RA may receive most of their care, routinely measure blood pressure during visits.

Despite the elevated risk for cardiovascular disease associated with rheumatoid arthritis, and regardless of their blood pressure levels, most patients with rheumatoid arthritis did not receive any documented communication regarding blood pressure, according to researchers.
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To examine the relationship between blood pressure levels and the likelihood that a patient with RA would receive documented communication regarding the risks for high blood pressure and CVD events, the researchers conducted a retrospective cohort study of 1,267 patients recruited through electronic health records at the University of Wisconsin division of rheumatology. Participants were patients with RA and uncontrolled hypertension, who received both primary and rheumatology care.

Trained abstractors reviewed RA clinic visit notes, searching for “blood pressure communication,” using a standardized tool to determine documentation aside from the recording of vital signs. The researchers used multivariate logistic regression to analyze the impact of blood pressure readings on likelihood of communication regarding blood pressure.

According to the researchers, 40% of patients in the study demonstrated blood pressure levels that meet the standard for uncontrolled hypertension. However, of the 2,677 RA clinic visits examined by the researchers, only 22% included any documented communication regarding blood pressure. After adjustments, the researchers calculated that only 31% of visits with significantly elevated blood pressure readings of 160/100 mm Hg or greater would include communication regarding blood pressure. In addition, the degree of blood pressure elevation did not affect the odds of communication, the researchers wrote. Less than 10% of examined RA clinic visits included documented communication recommending a follow-up appointment regarding the patient’s high blood pressure.

“Our findings should encourage patients to know their numbers and ask about their blood pressure results in all clinics, and should encourage rheumatology clinics to examine systems solutions to improve blood pressure follow up,” Bartels said. “Based on these findings, our team is studying evidence-based strategies to engage rheumatology clinic staff to help to connect timely primary care follow up after confirmed high blood pressures in rheumatology clinics.” – by Jason Laday

Disclosure: Bartels reports grant funding from Independent Grants for Learning and Change (Pfizer). Please see the study for all other authors’ relevant financial disclosures.