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Barber CEH, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, Lopatina E, Marshall DA. Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators. J Rheumatol 2016; 43:1965-1973. [PMID: 27481908 DOI: 10.3899/jrheum.160241] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. METHODS Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. RESULTS There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). CONCLUSION Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.
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Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia. .,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary.
| | - John M Esdaile
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Liam O Martin
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Peter Faris
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Selynne Guo
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Elena Lopatina
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
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Barber CEH, Marshall DA, Alvarez N, Mancini GBJ, Lacaille D, Keeling S, Aviña-Zubieta JA, Khodyakov D, Barnabe C, Faris P, Smith A, Noormohamed R, Hazlewood G, Martin LO, Esdaile JM. Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process. J Rheumatol 2015; 42:1548-55. [PMID: 26178275 DOI: 10.3899/jrheum.141603] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QI) for screening and use in rheumatology clinics. METHODS A systematic review was conducted of the literature on CVD risk reduction in RA and the general population. Based on the best practices identified from this review, a draft set of 12 candidate QI were presented to a Canadian panel of rheumatologists and cardiologists (n = 6) from 3 academic centers to achieve consensus on the QI specifications. The resulting 11 QI were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity, and feasibility in 3 rounds of online voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. RESULTS Response rates for the online panel were 86%. All 11 QI were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA; CV risk assessment; defining smoking status and providing cessation counseling; screening and addressing hypertension, dyslipidemia, and diabetes; exercise recommendations; body mass index screening and lifestyle counseling; minimizing corticosteroid use; and communicating to patients at high risk of CVD about the risks/benefits of nonsteroidal antiinflammatory drugs. CONCLUSION Eleven QI for CVD care in patients with RA have been developed and are rated as highly relevant, valid, and feasible by an international multidisciplinary panel.
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Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Nanette Alvarez
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - G B John Mancini
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Diane Lacaille
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Stephanie Keeling
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - J Antonio Aviña-Zubieta
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Dmitry Khodyakov
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Peter Faris
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Alexa Smith
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Raheem Noormohamed
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Glen Hazlewood
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Liam O Martin
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - John M Esdaile
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
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