Multimorbidity Screening Reduced Hospitalizations in Patients With Rheumatic Diseases

Systematic multimorbidity screening in patients with inflammatory rheumatic diseases (IRD) boosted preventive medication use and reduced hospital admissions in a recent study, which investigators say justify time and resource allocation for screening.¹

“The European Alliance of Associations for Rheumatology (EULAR) has issued recommendations aimed at enhancing multimorbidity prevention in IRD. Yet, implementing these guidelines in routine clinical settings poses significant challenges. Additional research is imperative to ascertain whether multimorbidity screening and management effectively mitigate the accumulation of multimorbidities in patients with IRD. This critical inquiry is essential for justifying resource allocation towards screening, notwithstanding the potential time and resource constraints,” lead investigator Claire Immediato Daien, professor, rheumatology, Centre Hospitalier Universitaire de Montpellier, France, and colleagues wrote.¹

Daien and colleagues analyzed data from 286 patients with IRDs who participated in the screening program (exposed) from the French national health database and 858 controls with IRDs, who were matched with multivariate analysis and propensity score matching ensuring compatibility. The study’s primary endpoint was a composite score assessing the dispensation of multimorbidity-preventing drugs, including vaccines, lipid-lowering agents, antiosteoporotic medications and antiplatelet drugs, during the year following the index date.

Overall, participants had a mean age was 56.7 years, and 60.5% were women. Most partiicpants had rheumatoid arthritis (73.4%) and 19.9% had spondyloarthritis. Among them, 76.9% were receiving corticosteroids, 65.4% were treated with conventional synthetic DMARDs (csDMARDs) and 65.7% with biologic DMARDs (bDMARDs). Propensity score matching produced 2 comparable populations with the exception of the use of antiosteoporosis drugs in the previous year (exposed, 14.6% vs control, 7.1%; P = .004).¹

The investigators found that the exposed patients met the endpoint at a higher rate than the unexposed patients (adjusted OR, 1.6 [95% CI, 1.2–2.2]; P <.01). This trend held in the propensity score-matched analysis, in which 54.8% of exposed patients met the endpoint compared with 44.5% of matched controls (OR, 1.5; P = .015).¹

In matched analyses, more exposed patients consulted a cardiologist and/or a pneumologist in the year following systematic screening compared with controls (OR, 2.2 [95% CI, 1.5–3.3]). Exposed patients also had a 58% reduction in emergency hospitalizations (OR, 0.4 [95% CI, 0.2–0.8]) and fewer hospitalizations due to infections (0.7% vs 3.9%; OR, 0.18; P = .03) than unexposed patients. Respiratory infections also decreased in the exposed population, but the relatively small number of events makes analysis difficult. Both groups had high antibiotic usage (64.4% vs 63.3%; P = .80). Exposed patients also had not significant trends of reduction in fractures (1.1% vs 2.5%; P = .22) and cardiovascular events (1.1% vs 1.8%; P = .48), although these were overall infrequent between groups.¹

Exposed patients had increased utilization of vaccines, cholesterol-lowering drugs and antiosteoporotic medications. Among vaccines, exposed patients received more pneumococcal (29.6% vs 14.8%; P <.001) and tetanus (16.6% vs 3.9%; P <.001) vaccines but equivalent influenza vaccines (15.1% vs 16.6%; P = .65).¹

“In conclusion, our study provides evidence supporting the effectiveness of systematic screening for multimorbidities in patients with IRD, leading to increased use of preventive medications and reduced hospitalization rates. Future research should further investigate the long-term impact of systematic screening on patient outcomes and address potential biases inherent in observational studies,” Daien and colleagues concluded.¹

REFERENCES

1. Immediato Daien C, Georgescu V, Decarriere G, Mercier G, Morel J. Systematic screening for multimorbidities in patients with inflammatory rheumatic diseases enhanced preventive medication use and reduced hospitalisations: an exposed-non-exposed study. RMD Open. 2024;10(4):e004490. Published 2024 Oct 2. doi:10.1136/rmdopen-2024-004490

2. Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020;79:39–52. doi:10.1136/annrheumdis-2019-21588