A new study has identified significant discrepancies between recommended cardiovascular disease (CVD) risk assessment guidelines and implementation in clinical practice for patients with rheumatoid arthritis (RA).

Despite the known risks of CVD, the researchers found that risk assessments are not routinely performed for patients with RA, leaving many patients with undetected heart disease.

The researchers conducted a retrospective review of medical records of patients newly diagnosed with RA in 2018 at an Irish tertiary rheumatology centre. Using chart data, they determined whether a CVD risk assessment had been conducted and how consistently healthcare professionals checked for risk factors, such as high blood pressure, cholesterol levels and smoking status, during regular rheumatology visits.

The primary outcome was documented CVD risk assessment (yes/no) over five years of routine care, and after any significant changes in RA treatment, as recommended by current guidelines. If the risk assessment was missing, a retrospective risk was calculated based on available data. The study was reported using the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology).

Identifying CVD risk assessments in RA

In 2018, the rheumatology outpatient department saw a total of 2,834 individual adult patients. Among them, 829 patients were diagnosed with RA that year, including 33 new patients, 21 of whom met the eligibility criteria for inclusion in this study.

Of the patient data analysed, no documented CVD risk assessments were identified in any of the 21 patient records. Screening for individual risk factors such as hypertension, dyslipidaemia, and smoking was also consistently inadequate for all patients.

Over half of the patients lacked sufficient clinical data to conduct a retrospective CVD risk assessment, and this was also true for a quarter of patients five years later.

For patients with adequate clinical data available to assess CVD risk from their records (n= 10), 80% were calculated to have an undetected moderate or higher CVD risk at the time of diagnosis. None of the patients had a documented referral to primary care for formal assessment.

The authors concluded that challenges exist in combining CVD risk management into the routine care of patients with RA, and that applying the guidelines in real-world clinical settings is difficult. Further research is needed to understand why this occurs and to identify the specific barriers that healthcare professionals face in implementing CVD guidelines for RA patients, they said.

Reference
Murphy L et al. Low adherence to cardiovascular risk assessment guidelines in patients with rheumatoid arthritis: a retrospective chart review of routine clinical practice. Rheumatol Int. 2025 Jun 26;45(7):158.