. 2015 Sep;42(9):1548-55.

doi: 10.3899/jrheum.141603. Epub 2015 Jul 15.

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

Claire E H Barber¹, Deborah A Marshall¹, Nanette Alvarez¹, G B John Mancini¹, Diane Lacaille¹, Stephanie Keeling¹, J Antonio Aviña-Zubieta¹, Dmitry Khodyakov¹, Cheryl Barnabe¹, Peter Faris¹, Alexa Smith¹, Raheem Noormohamed¹, Glen Hazlewood¹, Liam O Martin¹, John M Esdaile¹; Quality Indicator International Panel

Collaborators, Affiliations

Collaborators

Affiliation

¹ From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci

PMID: 26178275
PMCID: PMC4758831
DOI: 10.3899/jrheum.141603

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

Claire E H Barber et al. J Rheumatol. 2015 Sep.

. 2015 Sep;42(9):1548-55.

doi: 10.3899/jrheum.141603. Epub 2015 Jul 15.

Authors

Collaborators

Affiliation

¹ From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci

PMID: 26178275
PMCID: PMC4758831
DOI: 10.3899/jrheum.141603

Abstract

Objective: Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QI) for screening and use in rheumatology clinics.

Methods: A systematic review was conducted of the literature on CVD risk reduction in RA and the general population. Based on the best practices identified from this review, a draft set of 12 candidate QI were presented to a Canadian panel of rheumatologists and cardiologists (n = 6) from 3 academic centers to achieve consensus on the QI specifications. The resulting 11 QI were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity, and feasibility in 3 rounds of online voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology.

Results: Response rates for the online panel were 86%. All 11 QI were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA; CV risk assessment; defining smoking status and providing cessation counseling; screening and addressing hypertension, dyslipidemia, and diabetes; exercise recommendations; body mass index screening and lifestyle counseling; minimizing corticosteroid use; and communicating to patients at high risk of CVD about the risks/benefits of nonsteroidal antiinflammatory drugs.

Conclusion: Eleven QI for CVD care in patients with RA have been developed and are rated as highly relevant, valid, and feasible by an international multidisciplinary panel.

Keywords: CARDIOVASCULAR DISEASES; HEALTHCARE QUALITY INDICATORS; PRIMARY PREVENTION; RHEUMATOID ARTHRITIS.

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**Figure 1**
Methods for developing the quality indicator set for cardiovascular care in rheumatoid arthritis

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Comment in

Toward Quality of Cardiovascular Preventive Care for Patients with Rheumatic Diseases.
Davis JM 3rd. Davis JM 3rd. J Rheumatol. 2015 Sep;42(9):1539-41. doi: 10.3899/jrheum.150697. J Rheumatol. 2015. PMID: 26330123 No abstract available.

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References

1. Avina-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59:1690–7. - PubMed
1. Full LE, Monaco C. Targeting inflammation as a therapeutic strategy in accelerated atherosclerosis in rheumatoid arthritis. Cardiovasc Ther. 2011;29:231–42. - PubMed
1. Bergstrom U, Jacobsson LT, Turesson C. Cardiovascular morbidity and mortality remain similar in two cohorts of patients with long-standing rheumatoid arthritis seen in 1978 and 1995 in Malmo, Sweden. Rheumatology (Oxford) 2009;48:1600–5. - PubMed
1. Radovits BJ, Fransen J, Al Shamma S, Eijsbouts AM, van Riel PL, Laan RF. Excess mortality emerges after 10 years in an inception cohort of early rheumatoid arthritis. Arthritis Care Res (Hoboken) 2010;62:362–70. - PubMed
1. Gonzalez A, Maradit Kremers H, Crowson CS, Nicola PJ, Davis JM, 3rd, Therneau TM, et al. The widening mortality gap between rheumatoid arthritis patients and the general population. Arthritis Rheum. 2007;56:3583–7. - PubMed

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Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

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Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

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