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Feasibility of cardiovascular disease risk assessments in rheumatology outpatient clinics: experiences from the nationwide NOCAR project
  1. Eirik Ikdahl1,
  2. Silvia Rollefstad1,
  3. Grunde Wibetoe1,
  4. Anne Salberg2,
  5. Frode Krøll2,
  6. Kjetil Bergsmark3,
  7. Tore K Kvien3,
  8. Inge C Olsen3,
  9. Dag Magnar Soldal4,
  10. Gunnstein Bakland5,
  11. Åse Lexberg6,
  12. Clara G Gjesdal7,
  13. Christian Gulseth8,
  14. Glenn Haugeberg4,9 and
  15. Anne Grete Semb1
  1. 1 Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
  2. 2 Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
  3. 3 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4 Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
  5. 5 Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
  6. 6 Department of Rheumatology, Drammen Hospital, Drammen, Norway
  7. 7 Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
  8. 8 Department of Rheumatology, Betanien Hospital, Skien, Norway
  9. 9 Department of Rheumatology, Martina Hansen’s Hospital, Bærum, Norway
  1. Correspondence to Dr Eirik Ikdahl; eirik.ikdahl{at}


Objective The European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits.

Methods The NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients’ CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures.

Results Data collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres.

Conclusion Patients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.

  • cardiovascular disease
  • rheumatoid arthritis
  • ankylosing spondylitis
  • psoriatic arthritis
  • health services research

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  • Contributors We confirm that all authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and have approved this manuscript for submission.

  • Funding The work was supported by the South-Eastern Norway Regional Health Authority (grant no. 2013064).

  • Competing interests GH is founder and shareholder of the company DiaGraphIT, manufacturing GoTreatIT Rheuma. The other authors have received no financial support that could create a potential conflict of interests, or the appearance of such, with regard to the work.

  • Patient consent Not required.

  • Ethics approval The project has been approved by the local Data Protection Officers as a quality assurance project (2014/11741).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Some of the data from this project may be shared on request to the corresponding author.

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