Key messages
- I pazienti affetti da psoriasi hanno un rischio aumentato di malattia cardiovascolare, che rappresenta una delle principali cause di mortalità in tale popolazione.
- Tuttavia, molti di quei pazienti non hanno una relazione attiva con il medico di medicina generale e potrebbe avere un ruolo un medico specialista per la prevenzione cardiovascolare.
- Nella presente survey i dermatologi e i pazienti con psoriasi hanno manifestato un parere favorevole sull’opportunità di adottare un modello guidato da uno specialista per la prevenzione cardiovascolare.
Abstract
Importance
Patients with psoriatic disease are at increased risk of cardiovascular disease (CVD), which is a leading cause of mortality in this population. However, many of these patients do not have an active relationship with a primary care physician, and there may be a role for specialist-led care in prevention of CVD.
Objective
To explore clinician and patient perspectives regarding strategies to improve CVD prevention via specialist-led care.
Design, setting, and participants
Using electronically collected surveys, a best-worst scaling experimental survey study was conducted among dermatologists through the National Psoriasis Foundation as well as the American Academy of Dermatology from October 27, 2020, to April 1, 2021, to rank the strategies according to their potential to improve CVD prevention among patients with psoriatic disease. Participants were asked about the feasibility of specialist-led screening through an electronically delivered survey from the National Psoriasis Foundation conducted between February 1 and April 21, 2021. Patients with psoriatic disease were asked about whether they would like the specialist to screen for CVD risk factors. In addition, patients reported their likelihood to engage in CVD risk screening and management behaviors in scenarios in which either the primary care physician or specialist was making the recommendations.
Main outcomes and measures
For the clinician surveys, the primary outcome was the ratio scaled preference score (range, 0-100; higher is more preferred), as well as whether they think calculating a 10-year CVD risk score and prescribing statins seems feasible. For the patient surveys, the primary outcome was the likelihood to check cholesterol level, incorporate diet and exercise, or use statin therapy depending on whether recommended by the specialist or primary care physician, whether they would like their specialist to educate them about CVD risk, and whether they would find it convenient to have their cholesterol level checked by their specialist.
Results
Among 183 dermatologists (102 [55.7%] women; mean [SD] age not collected), clinical decision support (preference score, 22.3; 95% CI, 20.7-24.0), patient education (preference score, 14.1; 95% CI, 12.5-15.7), and clinician education (preference score, 15.8; 95% CI, 14.3-17.3) were ranked as strategies likely to improve CVD prevention in patients with psoriatic disease. In addition, 69.3% (95% CI, 62.2%-76.0%) of dermatologists agreed or strongly agreed that checking lipid levels was feasible. Among 160 patients with psoriasis and 162 patients with psoriatic arthritis (226 [70.2%] women; mean [SD] age, 54 [13.3] years), patients reported they were as likely to engage in cardiovascular risk screening and management behaviors whether recommended by their primary care physician or their specialist. In addition, 60.0% (95% CI, 52.0%-67.7%) of patients with psoriasis and 75.3% (95% CI, 67.9%-81.7%) of those with psoriatic arthritis agreed that it would be convenient for them to have their cholesterol checked by their dermatologist/rheumatologist.
Conclusions and relevance
In this survey study, dermatologists and patients with psoriatic disease expressed positive perspectives about engaging in a specialist-led model of care to improve CVD prevention. Dermatologists appear to view several strategies as having potential to improve cardiovascular risk prevention.