Specialist-led interventions may improve cardiovascular outcomes in psoriatic disease
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Cardiovascular screening and management programs led by dermatology providers for patients with psoriasis may fill gaps left in the absence of primary care, according to survey findings that included both dermatologists and patients.
“While patients with psoriasis and psoriatic arthritis are at greater risk of heart disease, they are less likely to have risk factors for heart disease identified and treated,” John S. Barbieri, MD, MBA, of the department of dermatology at Brigham and Women's Hospital in Boston, told Healio. “Since many patients may not have an active relationship with a primary care provider, there may be an opportunity to take advantage of their relationship with their dermatologist or rheumatologist who is managing their psoriatic disease to make sure risk factors for heart disease are addressed as well.”
In the experimental survey study, Barbieri and colleagues gathered both physician and patient input on how to use specialist-led care to prevent cardiovascular outcomes in the psoriatic disease setting. Dermatologists and patients were surveyed through the National Psoriasis Foundation and/or the American Academy of Dermatology. Participants were asked about behavior management and screening for cardiovascular risk factors conducted by a primary care physician or specialist.
The primary endpoints for physicians included ratio-scaled preference scores from 0 to 100, with higher scores more preferred, for various interventions; the feasibility of prescribing statins; and the utility of a 10-year cardiovascular disease risk score. For patients, primary outcomes included the likelihood of checking their own cholesterol levels, improve diet and exercise habits and use statins as prescribed by a PCP or specialist; the possibility of CVD risk education; and interest in having cholesterol checked by a specialist.
There were 183 dermatologists (55.7% women) surveyed. Findings showed that clinical decision support garnered a preference score of 22.3 (95% CI, 20.7-24), while the scores were 14.1 (95% CI, 12.5-15.7) for patient education and 15.8 (95% CI, 14.3-17.3) for clinician education as cardiovascular disease prevention strategies in patients with psoriatic disease.
Other findings from the survey of dermatologists showed that 69.3% (95% CI, 62.2%-76%) strongly agreed or agreed that checking lipid levels was feasible.
The patient survey included 160 individuals with psoriasis (mean age, 54 years; standard deviation, 15.2 years; 60% women) and 162 with psoriatic arthritis (mean age, 54 years; standard deviation, 11.4 years; 80.2% women). Patients reported equal likelihood of engaging in cardiovascular risk screening and management as recommended by a PCP or specialist.
Other findings showed that 60% (95% CI, 52%-67.7%) of patients in the psoriasis group and 75.3% (95% CI, 67.9%-81.7%) of those in the psoriatic arthritis group agreed on the convenience of a dermatologist or rheumatologist checking their cholesterol.
Barbieri acknowledged some limitations of the data set but explained why the findings are important.
“While we did not specifically examine why patients may not have an active relationship with a primary care provider in this study, others have noted that use of primary care services is declining over time,” he said. “Potential causes such as decreased demand for primary care services, cost and coverage issues, along with use of alternative sources of care, have been reported.”
In speaking directly to the dermatology community, Barbieri stressed that psoriasis can have manifestations beyond the skin.
“While patients with psoriasis are at increased risk for cardiovascular disease, some studies have found that approximately half of patients have undiagnosed or undertreated cardiovascular risk factors,” he said. “As a result, it is important for dermatologists to educate patients about this risk and to help ensure that risk factors are identified and managed. For those who feel comfortable, consider screening for traditional risk factors such as hyperlipidemia, diabetes, hypertension and smoking, as well as calculating a 10-year risk score to stratify risk for heart disease.”
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