Psoriasis and Cardiovascular Screening Rates in the United States

January 2013 | Volume 12 | Issue 1 | Original Article | 14 | Copyright © January 2013

Habibollah S. Alamdari BAa , Cheryl J. Gustafson MDa , Scott A. Davis MAa , William Huang MD MPHa , and Steven R. Feldman MD PhDa-c

aDepartment of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC bDepartment of Pathology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC cD

Abstract
Background: Guidelines to screen for cardiovascular (CV) risk factors in psoriasis patients have been established. However, the frequency with which dermatologists and nondermatologists screen psoriasis patients for CV risk factors is not well characterized.
Purpose: To determine how frequently psoriasis patients are screened for CV risk factors in the ambulatory care setting and to identify factors affecting screening rates.
Methods: Data from the 2005 to 2009 National Ambulatory Medical Care Survey (NAMCS) were analyzed to determine screening rates for blood pressure, glucose, cholesterol, and body mass index (BMI). The probability of a patient having at least 1 of the 4 risk factors screened was determined and was termed the "composite" score. Screening rates were assessed by physician specialty, patient demographics, and clinical practice characteristics.
Results: There were an estimated 11.4 million psoriasis patient visits from 2005 to 2009. Blood pressure, glucose, cholesterol, and BMI were evaluated at 32.2%, 5.9%, 9%, and 26% of psoriasis visits, respectively, with a composite score of 41.2%. Patients without psoriasis were screened for these CV risk factors at 59.0%, 6%, 8%, and 38.1% of outpatient visits, respectively, with a composite score of 66.3%. The results of a multivariate analysis accounting for patient age differences indicated psoriasis had a statistically significant effect on rates of blood pressure and BMI screening. In general, screening rates were higher if the patient was male, African American, or non-Hispanic, and screening rates were relatively equal across age groups. Higher screening rates were also associated with primary care specialties, faculty practice or community health clinics with contracted physicians, clinics that utilized electronic medical records, practices with a higher percentage of revenue from a Medicare/Medicaid payer, or offices with discounted fees and capitation payment structures.
Limitations: Data from NAMCS are cross-sectional, permitting assessment of screening rates based on visits but not on patients.
Conclusions: Screening for high blood pressure, diabetes, hypercholesterolemia, and obesity are not performed at most outpatient visits for psoriasis. Care should be taken to ensure that patients do receive appropriate screening for the comorbidities associated with psoriasis.

J Drugs Dermatol. 2013;12(1):e14-e19.

INTRODUCTION

Psoriasis is associated with multiple comorbidities, including psoriatic arthritis, diabetes mellitus, hypertension, metabolic syndrome, depression, and increased alcohol and tobacco use. Overall, cardiovascular (CV) comorbidities present the greatest risk to patient health. Compared with the general population, patients with psoriasis are at an increased risk for developing CV risk factors. For instance, patients with severe psoriatic disease are 5 times more likely than patients without psoriasis to require antihypertensive medications, have a 2-fold higher risk for myocardial infarction, and have a decreased life span by as much as 4 years.1-3
The National Psoriasis Foundation released CV risk screening guidelines in 2008.4 The frequency with which dermatologists and nondermatologists screen psoriasis patients for CV risk factors is not well characterized in the medical literature. Therefore, the main objective of this study was to determine how often CV risk factors are screened for during outpatient visits. In addition, we assessed how patient demographics and outpatient clinic characteristics are associated with CV risk screening rates.

METHODS

This study is a retrospective analysis. Data from the National Ambulatory Medical Care Survey (NAMCS) from 2005 to 2009 were used to assess how often psoriasis patients were screened for CV risks at outpatient visits. The NAMCS is an ongoing survey of non–federally employed, office-based physician practices in the United States. It has been conducted by the National Center for Health Statistics since 1974 to estimate the use of ambulatory care services in the United States. For each visit sampled, a 1-page patient log is completed, which includes information such as patient demographics, presenting symptoms, physicians' diagnoses, and services provided, including diagnostic tests, medications, and referral practices. Collected data are entered into a multistage probability sample to produce national estimates regarding the utilization of ambulatory care services in the United States.
The NAMCS was queried for data regarding psoriasis and nonpsoriasis patient visits from 2005 to 2009. Psoriasis visits were identified using International Statistical Classification of Dis-