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

Christie M. Bartels, Amy J.H. Kind, Carolyn T. Thorpe, Christine M. Everett, Rachel J. Cook, Patrick E. McBride, Maureen A. Smith

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)9-16
Number of pages8
JournalSeminars in Arthritis and Rheumatism
Volume42
Issue number1
DOIs
StatePublished - Aug 2012
Externally publishedYes

Keywords

  • Cardiovascular disease
  • Cholesterol
  • Prevention and control
  • Preventive medicine
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

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