Cardiology co-management of rheumatoid arthritis patients with coronary artery disease as an intervention reduces hospitalization rates and adverse event occurrence.

INTRODUCTION: Rheumatoid arthritis (RA) is a systemic autoimmune disease with important cardiovascular (CV) implications. CV disease represents over half of RA patient deaths and causes significant morbidity. CV manifestations in RA can be complex, raising concerns for adequate patient management and provider-dependent roles. METHODS: This is a retrospective study of patients diagnosed with RA and coronary artery disease (CAD). Patients were identified and filtered via EPIC Database search engine. Parameters were set from January 1, 2014, to December 31, 2020. Inclusion criteria consisted of patients who met diagnostic criteria for both RA and CAD. A total of 399 patients met criteria. RESULTS: Of the 399 identified patients, 272 were female (68.2%) and 127 were male (31.8%) with a median age of 73 (range 26-98). The population was further divided into two groups: those with established cardiology care versus those without. Patients without cardiology follow-up experienced significantly more hospitalizations (RR 1.63 95% CI 1.12, 2.38), higher rates of adverse events including myocardial infarction (MI) (RR 4.82 95% CI 1.94, 11.98), heart failure (HF) (OR 15.81 95% CI 3.54, 70.52), and stroke (RR 2.55 95% CI 1.29, 5.03). Patients not followed by cardiology also had numerical increases in CV death (4 deaths compared to none in those with cardiology follow) and all-cause mortality (HR 1.03 95% CI 0.63, 1.67). CONCLUSION: Patients with regular cardiology follow-up demonstrated fewer cardiac-related adverse events. This suggests that co-management may have a role in adverse cardiac event risk reduction and should therefore be an early consideration. Key Points • Rheumatoid arthritis patients demonstrate higher rates of coronary disease compared to the general population. Traditional cardiac risk factors may not be entirely responsible for this phenomenon • Hospitalization rates and adverse event occurrence are significantly higher in patients with single-provider care (rheumatology only) compared to dual provider care (rheumatology and cardiology) • Cardiology co-management should be an early consideration in the management of RA patients • Early screening, risk stratification of coronary disease, and utilization of appropriate treatment algorithms are important to decrease morbidity and mortality.

Retrospective Analysis of Population Demographic Characteristics, Medical Interventions, and Resource Use at a Medical Student-Run Clinic on the Texas-Mexico Border.

PURPOSE: The study's purpose was to assess population demographics and resource utilization of the Medical Student Run Clinic, which provides primary care services to patients in El Paso, Texas along the Texas-Mexico border. METHODS: A retrospective cross-sectional chart review was performed on 760 patients evaluated at the medical student-run clinic between 2013 and 2016. Data included demographic characteristics, chief complaints, diagnoses, and interventions, which were analyzed with calculations of means, standard deviations, and percentages. RESULTS: Most (79.7%) patients were female; average age was 38.43 years; 91% of patients were Hispanic, and 66.8% spoke Spanish. Average BMI was 30.9 kg/m2. Less than 1% of patients presented with a psychiatric complaint; however, 17.9% screened positive for anxiety, and 16.5% screened positive for depression. CONCLUSIONS: This study shows that diabetes, hypertension, obesity, anxiety, and depression represent avenues for future patient-centered interventions and provide insight into challenges patients face along the border.