Cardio-Rheumatology Center: Seamless Collaboration for Complex Conditions

The inflammation at the core of so many autoimmune conditions increases the risk for cardiovascular diseases. Glucocorticoids, frequently used in the treatment of immunologic conditions, also can have an impact on heart health over time.

Delivering effective, multidisciplinary care for patients with these conditions is why Cleveland Clinic developed its Cardio-Rheumatology Center several years ago. Clinicians there work together to manage complex cardiovascular disease in patients with arthritis, systemic lupus erythematosus (SLE), systemic sclerosis, various types of vasculitis or psoriatic arthritis.

The dedicated center goes beyond simple referrals to streamline patient access and to ensure that diagnosis and treatment are conducted by specialists working in sync.

“In rheumatology, so many conditions have a cardiology aspect,” says Rula Hajj-Ali, MD, Associate Director of Cleveland Clinic’s Center for Vasculitis Care and Research. “We see patients who come in after surgery for an aortic aneurysm that turns out to be from vasculitis, for example. Lupus and scleroderma also have a lot of heart involvement.”

The center also brings a whole-patient approach, which includes counseling and monitoring for increased risk of cardiovascular diseases in patients with autoimmune conditions, she adds. Cardiologist Heba Wassif, MD, MPH, Director of the center, says an increasing understanding of the impact of autoimmune conditions on overall health has led to the development of cooperative care models.

“Evidence from other disciplines shows that it’s better for the patient to have teams regularly working together,” says Dr. Wassif. “You don’t develop a team if you only have a consult once in a while.”

Complex diseases, coordinated care

A recent case illustrates why the cardio-rheumatology clinic is needed, says Dr. Wassif.

The patient was referred to Cleveland Clinic cardiologists for a large thrombus in the left ventricle caused by Loeffler’s syndrome. The condition is characterized by congestion that can be idiopathic, triggered by an allergic response or due to infiltration of the lungs by foreign particles or parasites. This patient needed to be on blood thinners but was also having bleeding issues.

Clinicians from both sides worked to identify appropriate anticoagulant and immunosuppressive medications. The thrombus has been responding to the anticoagulant.

“That's the purpose of the cardio-rheumatology clinic,” Dr. Wassif says. “It's not just noting that a patient has an increased risk of cardiovascular disease, but it’s the management of patients with autoimmune conditions.”

In addition to clinical work, the teams collaborate on research and professional and patient-group education.