Improving Cardiovascular Outcomes in the Psoriasis Cohort. Psoriasis and Cardiovascular Disease-Clinician Knowledge, Practice and Perceptions

Abstract

Background: Psoriasis is a risk factor for cardiovascular disease (CVD). This risk is independent and incremental to traditional cardiovascular (CV) risk factors, but clinician and patient perspectives on this risk are unclear. This study aims to assess the knowledge, perceptions, and practice of clinicians and patients with respect to psoriasis and CVD.

Methods: This cross-sectional study consisted of a self-administered questionnaire capturing demographic characteristics, knowledge of the association between psoriasis and CVD, and perspectives on CV screening and management. This was distributed to members of relevant Australasian Speciality Medical Colleges, speciality societies, and psoriasis patients in public and private clinic settings. Survey data were assessed using descriptive statistics. Logistic regression was used to investigate the relationship between categorical variables and the outcome variable, for example, to determine factors predictive of clinician knowledge and perceptions. For all analyses, a p-value of less than 0.05 was considered statistically significant.

Results: A total of 298 clinicians (dermatologists (86), rheumatologists (56), cardiologists (53), general practitioners (103)) and 102 patients with psoriasis were surveyed. Regarding clinician knowledge of the association between psoriasis and CVD, dermatologists and rheumatologists indicated knowledge of this association (98.8%) (85/86) and 91.1% (51/56) respectively, while only 54.7% (29/53) of cardiologists and 29.1% (30/103) of GPs indicated knowledge of this association. Only 23.5% (24/102) of patients surveyed indicated knowledge of this association. Clinicians with a higher proportion of their caseload including psoriasis patients were significantly more likely to be aware of the association between psoriasis and CVD (OR 3.05 [1.64, 5.68]; p < 0.001). Most clinicians nominated GPs as best placed to facilitate CV risk factor screening and management (dermatologists 80.2% (69/86); rheumatologists 83.9% (47/56); cardiologists 75.5% (40/53); GPs 88.3% (91/103)). Patients preferred specialist input and multidisciplinary care for CVD risk management; 34.3% (35/102) nominated a cardiologist as the preferred clinician, and 23.5% (24/102) indicated preference for a multidisciplinary team.

Limitations: The possibility of sampling and response bias, inherent in the study design, is acknowledged; however, responses are likely representative of clinician and patient sentiments on this issue and in keeping with similar study findings.

Conclusion: Clinician and patient knowledge of the relationship between psoriasis and CVD needs to be improved. The establishment of a national consensus approach to address this gap in clinical care is needed.

Keywords: cardiovascular disease; clinicians; patients; psoriasis; survey.

FIGURE 1

Clinician knowledge of the association between CVD and psoriasis. “Are you aware of a relationship between cardiovascular disease (CVD) and psoriasis?”.

FIGURE 2

Clinician regard for psoriasis as a clinically relevant cardiovascular risk factor. “Do you regard Psoriasis as a clinically relevant cardiovascular risk factor (i.e. akin to hypertension, dyslipidaemia, diabetes mellitus?”.

FIGURE 3

Proposed collaborative care model for CVD prevention in patients with psoriasis. GP‐led screening and management is central. Cardiologist involvement may be required for more complex patients. Dermatologist and rheumatologist initiation of CV screening may be appropriate with GP‐directed management. CVD, cardiovascular disease; PsO, psoriasis; GP, general practitioner.