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

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.

• Authors: Claire E H Barber, Deborah A Marshall, Nanette Alvarez, G B John Mancini, Diane Lacaille, Stephanie Keeling, J Antonio Aviña-Zubieta, Dmitry Khodyakov, Cheryl Barnabe, Peter Faris, Alexa Smith, Raheem Noormohamed, Glen Hazlewood, Liam O Martin, John M Esdaile, Quality Indicator International Panel
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 42 Issue 9 Pg. 1548-55 (Sep 2015) ISSN: 0315-162X [Print] Canada
• PMID: 26178275 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents

Topics

• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (complications, drug therapy)
• Cardiovascular Diseases (etiology, prevention & control)
• Consensus
• Evidence-Based Medicine
• Humans
• Internet
• Quality Indicators, Health Care
• Risk Assessment