AB0326 RECOGNITION AND IMPLEMENTATION OF EULAR RECOMMENDATIONS FOR RHEUMATOID ARTHRITISCARDIOVASCULAR RISK MANAGEMENT AMONG INTERNAL MEDICINE AND RHEUMATOLOGY FELLOWS: DATA FROM AN ACADEMIC TERTIARY CARE LEVEL CENTER
Authors: Guillermo Guaracha-Basáñez, Irazú Contreras-Yáñez, Alfonso Gulias-Herrero, Virginia Dr. Pascual
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) patients present an increased risk of cardiovascular (CV) morbidity and mortality compared to the general population. Patients from Latin-America present distinctive features and some of them are relevant when assessing CV risk. EULAR recommendations include CV risk assessment for all the patients at least once every 5 years and its reconsideration following major changes in anti-rheumatic therapy. Importantly, failure to identify and manage CV comorbidity in RA patients has been recognized by rheumatologists, although there is no information in Latin-America. <h3>Objectives</h3> To investigate knowledge about EULAR recommendations for RA-CV risk assessment/management (K-EULAR-R) among internal medicine and rheumatology fellows from an academic and tertiary care level center, to identify physician's perception about responsible(s) for CV risk assessments and about major barriers to perform the assessments and to investigate the appropriated identification of major CV risk factors. Potential differences among both group of trainees were additionally investigated. <h3>Methods</h3> Internal medicine fellows (N=105, 1<sup>st</sup> to 4<sup>th</sup> grade participants were represented) and rheumatology fellows (N=10, 4 from first grade and 6 from second grade) were invited to anonymously answer a questionnaire designed by 2 investigators to investigate K-EULAR-R and integrated by 11 items classified in 3 categories: "general knowledge about CV risk in RA patients" (4 items), "timing of CV risk assessment" (4 items) and "appropriated statin use" (3 items). In addition, fellows were directed to select and rate main responsible for CV risk assessment (5 options), major barriers to apply EULAR recommendations (6 options), and to correctly identify CV risk factors (20 options). After questionnaire completion, an overall-CV-knowledge-Likert scale (superior, borderline or inferior) was assigned to each participant by an independent observer. The study received IRB approval. Descriptive statistic was used and questionnaire was scored to a decimal scale. <h3>Results</h3> Ninety-three (85%) internal medicine fellows and 10 (100%) rheumatology fellows participated. Rheumatology fellows scored higher in the K-EULAR-R questionnaire when compared to internal medicine fellows (6.9±1.4 vs. 5.5±1.4, p=0.004) and the higher score was replicated in the category of "general knowledge about CV risk" (8.3±2.0 vs 5.3±2.5, p=0.001), meanwhile no differences were detected in the scoring of the categories "timing of CV risk assessment" and "appropriated statin use". No differences among grades within each group were identified. The majority of the rheumatology fellows rated themselves as the specialist responsible for CV risk assessment (80%); meanwhile this percentage decreased to 45.7% among the internal medicine fellows (p=0.084); fellows from both groups identified lack of time during rheumatic evaluations as the main barrier to perform CV risk assessment (60% and 57%, respectively). Adequate CV risk factor identification varied from 30% (for contraceptive use) to 100% (for smoking habit), and these% were similar among both groups. Up to 82.5% of the fellows identified incorrectly ≥ 1 CV risk factor and high serum triglyceride levels was the highest (49%). <h3>Conclusion</h3> Knowledge about CV risk management in RA patients was suboptimal among trainees in internal medicine and rheumatology from an academic and tertiary care level center in México City; trainees in rheumatology performed better. There is a need to reinforce the topic during fellow's residency. <h3>Disclosure of Interests</h3> None declared