Specialist-Led CVD Prevention Model Supported by Physicians and Patients With Psoriasis

A specialist-led care model for cardiovascular disease (CVD) prevention has received positive support from dermatologists and those with psoriatic disease, according to a scaling survey recently published in the Journal of Cosmetic Dermatology.

This best-worst survey study included 183 dermatologists (55.7% women) and 322 individuals (70.2% women) with psoriasis (n=160) or psoriatic arthritis (n=162). Surveys were completed from October 27, 2020, to April 1, 2021. Clinicians were asked to rank strategies and respond to questions on the feasibility of specialist-led screening. Participants were asked whether they would prefer the specialist to perform CVD risk factor screening, as well as how likely they would be to participate in such screening and subsequent behavior management. The primary outcomes for clinician surveys were the ratio-scaled preference score (0-100) and whether they believed it was feasible to calculate a 10-year CVD risk score and prescribe statins. The primary outcomes for those with psoriatic disease were their likelihood of checking cholesterol levels, modifying diet and exercise behaviors, and/or using statin therapy depending on clinician recommendations; whether they would opt for CVD risk education from their specialist; and whether they would prefer to have their specialist check their cholesterol levels.

In the survey of dermatologists, the strategies selected as most likely to improve CVD risk prevention were physician educational outreach (preference score 15.8; 95% CI, 14.3-17.3), clinical decision support (preference score 22.3; 95% CI, 20.7-24.0), and educational materials for patients with psoriatic disease (preference score 14.1; 95% CI, 12.5-15.7). In addition, 69.3% (95% CI, 62.2-76.0) agreed or strongly agreed that it was feasible to check lipid levels. Those with psoriatic disease reported being as likely to receive CVD risk screening and management behaviors from their specialist as from their primary care physician. In response to a question regarding the convenience of having their cholesterol checked by their dermatologist or rheumatologist, 60% (95% CI, 52.0-67.7) of those with psoriasis and 75.3% (95% CI, 67.9-81.7) of those with psoriatic arthritis agreed that it would be convenient.

Limitations to this study include potential response and sampling bias, a potential lack of generalizability to nonresponders, the possibility that excluding prior statin use influenced the study’s lower incidence of chronic conditions, the use of only 8 potential implementation strategies, and the possibility that survey responses may not reflect actual behavior.

The study researchers concluded, “Patients with psoriatic disease are at higher risk [for] CVD; however, care to address their risk factors is not adequately managed.” They further indicated that “a specialist-led model of care has the potential to improve CVD risk management in this population,” and “both clinicians and patients expressed interest in such a model, particularly if it includes clinical decision support, patient education, and clinician educational outreach.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Barbieri JS, Beidas RS, Gondo GC, et al. Analysis of specialist and patient perspectives on strategies to improve cardiovascular disease prevention among persons with psoriatic disease Published online January 19, 2022. JAMA Dermatol. doi:10.1001/jamadermatol.2021.4467