Penn Medicine, Philadelphia: Coordinated Care and Education Program Shows Potential in Identifying and Managing Cardiovascular Disease Risk in Psoriasis and Psoriatic Arthritis Patients

Almost 30 percent of the patients in a pilot program for those with psoriasis that was devised by researchers from the Perelman School of Medicine at the University of Pennsylvania were identified as having undiagnosed, elevated risk for cardiovascular disease. That 30 percent of high-risk patients were then able to be given more individualized care over the next year, but all participants received extra care and guidance. Patients gave favorable reports of the program — which linked them to a care coordinator with the National Psoriasis Foundation, signaling that dermatologists and rheumatologists may have a roadmap that they can build upon toward better preventing cardiovascular disease. The team’s experiences are detailed in a new research letter in the Journal of Investigative Dermatology.

“This program has the potential to ensure that we’re empowering patients and clinicians to better identify cardiovascular risk factors in order to prevent heart attacks, stroke, and premature mortality in patients with psoriatic disease who are predisposed to poor cardiovascular health,” said Joel Gelfand, MD, the James J. Leyden, M.D. Endowed Professor in Clinical Investigation in the department of Dermatology at Penn.

Psoriasis, a skin, joint, and immune system disease which often manifests as itchy, dry scales, and patches on the skin, occurs when skin cells over-multiply in response to an overactive immune system. Along with skin irritation, a host of other conditions are linked to the disease, including certain cancers, liver and kidney disease, arthritis, and especially diabetes and atherosclerosis.

Over 80 patients with psoriasis or psoriatic arthritis (termed psoriatic disease) at four different dermatology and rheumatology practices across the United States were enrolled in the pilot program. During the course of a year, participants received blood tests to measures their lipids and hemoglobin A1C, took at-home blood pressure recordings, and had virtual meetings with care coordinators at the National Psoriasis Foundation. All 80 patients received recommendations on diet and exercise customized for people with psoriatic disease who often have trouble with physical activity due to skin and joint symptoms.

Additionally, the clinicians identified 23 patients who had previously undiagnosed increased risk for cardiovascular disease at the outset of the program, roughly 28 percent of the participants, and those patients were then provided with recommendations based on guidelines from the American Heart Association and connected to their primary care provider. That included recommendations for blood pressure and cholesterol medications based on national guidelines.

Few specialists initiate screening for cardiovascular risk factors in people with psoriatic disease even though these patients are at increased risk for high blood pressure, elevated cholesterol, diabetes, and cardiovascular mortality, Gelfand said.

“Our prior work demonstrated that care coordination was a missing link that specialists and patients need to achieve better cardiovascular education, screening, and treatment of risk factors,” Gelfand said. This pilot study demonstrated overwhelmingly that a centralized care coordinator model is promising to help narrow the evidence to practice gap when it comes to preventing heart attack, stroke and premature mortality in our patients.”

While the takeaways from this pilot program should urge further collaboration between dermatologists, rheumatologists, and cardiologists and a formal structure for that collaboration, there’s a message for patients, too.

“People with psoriasis should be aware of the link between psoriasis and their cardiovascular health so they can advocate for themselves and do the daily things that keep their heart healthy and their blood pressure, cholesterol, and weight in check,” said Gelfand.

The findings inspired Gelfand and his colleagues to launch a bigger trial of this program which will involve over 500 patients at 10-20 centers in the United States.

Researchers from New York University, Brigham and Women’s Hospital, SUNY at Buffalo, the University of Washington, the University of California Los Angeles, George Washington University, and Northwestern University were also involved in the research.