Over 1.3 million Americans have rheumatoid arthritis (RA), which nearly doubles their risk for early cardiovascular disease (CVD) death. In recent decades, gains in CVD preventive care in the have saved lives, yet the mortality gap between RA patients and peers is widening. Dr. Bartels'preliminary work has shown that nationally, older adults with RA receive less lipid testing than reported in peers without RA, despite higher CVD risk and a mean of 9 physician encounters each year. The rheumatologist may hold knowledge regarding RA- specific CVD risk and frequent encounter opportunities, but CVD prevention is traditionally delivered by primary care physicians (PCPs). To narrow the mortality gap for RA patients, it is critically important to study how rheumatologists can support the management of modifiable CVD risk factors in collaboration with PCPs. Dr. Bartels'goal is to be an academic rheumatologist leading an independent research program to improve the cardiovascular health and survival of patients with inflammatory rheumatic diseases. She proposes a 3-year K23 period with training in advanced statistics, barrier analysis, and translational research interventions. Following her KL2 support Dr. Bartels is ideally positioned for a successful award period with focused training, expert mentorship, and a research plan that creates a platform to transition to independence, including future R01 support and a long-term research program aimed at closing CVD prevention gaps and improving survival. The proposed aims are to identify patient, provider, and clinic predictors of rheumatologist to PCP communication regarding CVD risks (Aim 1) and the impact of these communications on blood pressure (BP) and lipid management (Aim 2). Specifically, the project will examine the effect of the frequency and intensity of rheumatologist CVD risk-communications on hypertension diagnosis, BP control, and lipid testing and control for 1,800 RA patients within one of the ten largest US multispecialty groups.
Aim 3 will identify barriers and facilitators of CVD preventive care deliver for patients with RA using focus groups of RA patients and physicians. The proposed work aligns directly with NIAMS'2010-2014 Long Range Plan to study """"""""interactions between rheumatic diseases and common co-morbid conditions, such as atherosclerosis, to design effective risk management strategies"""""""" and """"""""effects of patient-health care system interactions in disease outcomes."""""""" Now is a critical time to identify how specialists can support CVD preventive care given its potential to reduce mortality for inflammatory rheumatic disease patients.
RA confers 60% greater risk of CVD events, including death, and the mortality gap is widening. Given that rheumatologists are aware of these concerns but CVD prevention is traditionally delivered by primary care physicians, the objective of my proposal is to examine the impact of CVD risk communications by rheumatologists to primary care physicians and to identify barriers and facilitators to CVD prevention from patient and provider perspectives. To narrow the mortality gap for RA patients, it is critically important to study how rheumatologists can support the management of modifiable CVD risk factors in collaboration with primary care providers.
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