Lipid Testing in Patients with Rheumatoid Arthritis and Key Cardiovascular-Related Comorbidities: A Medicare Analysis

• Published in: Seminars in arthritis and rheumatism Vol. 42; no. 1; pp. 9 - 16
• Main Authors: Bartels, Christie M., MD, MS, Kind, Amy J.H., MD, PhD, Thorpe, Carolyn T., PhD, MPH, Everett, Christine M., MPH, PAC, Cook, Rachel J., MD, MS, McBride, Patrick E., MD, MPH, Smith, Maureen A., MD, PhD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2012; Elsevier
• Subjects: Aged; Aged, 80 and over; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - epidemiology; Biological and medical sciences; cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; cholesterol; Comorbidity; Diabetes Mellitus - blood; Diabetes Mellitus - epidemiology; Diseases of the osteoarticular system; Female; Humans; Hyperlipidemias - blood; Hyperlipidemias - epidemiology; Inflammatory joint diseases; Lipids - blood; Male; Mass Screening - methods; Medical sciences; Medicare - statistics & numerical data; prevention and control; preventive medicine; Primary Health Care; Retrospective Studies; rheumatoid arthritis; Rheumatology; United States - epidemiology; United States; cardiovascular disease; cholesterol; prevention and control; rheumatoid arthritis; preventive medicine; Human; Immunopathology; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Lipids; Cardiovascular disease; Inflammatory joint disease; Cholesterol; Medicine; Prevention; Chronic; Rheumatoid arthritis
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2012.01.005

Objective For patients with rheumatoid arthritis (RA) and comorbid cardiovascular disease (CVD), diabetes, or hyperlipidemia, annual lipid testing is recommended to reduce morbidity and mortality from comorbidities. Given trends encouraging complex patients to receive care in “medical homes,” we examined associations between regularly seeing a primary care provider (PCP) and lipid testing in RA patients with cardiovascular-related comorbidities. Methods We performed a retrospective cohort study examining a 5% random USA Medicare sample (2004-06) of beneficiaries over 65 years old with RA and concomitant CVD, diabetes, or hyperlipidemia ( n = 16,893). We examined the relationship between receiving lipid testing in 2006 and having at least 1 PCP visit per year in 2004, 2005, and 2006 using multivariate regression. Results Ninety percent of patients had prevalent CVD; 46% had diabetes, and 64% had hyperlipidemia. However, annual lipid testing was only performed in 63% of these RA patients. Thirty percent of patients saw a PCP less than once per year, despite frequent visits (mean >9) with other providers. Patients without at least 1 annual PCP visit were 16% less likely to have lipid testing. Increased age, complexity scores, hospitalization, and large town residence predicted decreased lipid testing. Conclusions Despite comorbid CVD, diabetes, or hyperlipidemia, 30% of Medicare RA patients saw a PCP less than once per year, and 1 in 3 lacked annual lipid testing. Findings support advocating primary care visits at least once per year. Remaining gaps in lipid testing suggest the need for additional strategies to improve lipid testing in at-risk RA patients.