High-risk psoriasis patients are not consistently escalated to cardiovascular specialist care
S Mai, B Bongue, T Franck, C Rondelard, D Viallard, G Cizeron, F Maccari, D Simonian, B Trombert, J L PerrotAbstract
Background
Psoriasis is associated with increased cardiovascular (CV) morbidity and premature mortality. Clinical guidelines recommend systematic CV risk assessment, yet how elevated CV risk translates into specialist escalation within coordinated healthcare systems remains unclear. In general practitioner-led models, referral to cardiology reflects progression beyond primary prevention. Whether escalation occurs consistently in CV high-risk patients is unknown.
Purpose
We evaluated cardiology consultation patterns among psoriasis-treated patients with CV risk in a structured healthcare system. We hypothesised that specialist escalation would increase with CV burden but remain heterogeneous across patient groups.
Methods
We conducted a population-based cross-sectional study using French regional health insurance reimbursement data (2023–2025). We identified adults treated for psoriasis using medication records. We defined cardiovascular risk factors (CVRFs) and established cardiovascular diseases (CVDs) using treatment and procedure codes over 24 months. We identified cardiology consultations from specialist billing claims. We used multivariable logistic regression to identify predictors of absent specialist consultation among CV high-risk patients engaged in primary care.
Results
Among 10,331 psoriasis- treated adults, 53.9% had at least one CVRF and 14.4% had established CVDs. Primary care engagement reached 97.5% among individuals with ≥1 CVRF. Overall, 57.4% of CV high-risk patients had no recorded cardiology consultation. Escalation increased with CV burden but remained incomplete: 35.4% of patients with three or more CVRFs and 30.4% of those with established CVDs had no recorded specialist involvement. Younger age, female sex and low-income coverage independently predicted absence of referral. Psoriasis treatment intensity did not influence escalation patterns.
Conclusions
Specialist escalation in CV high-risk psoriasis patients remains inconsistent despite near-universal primary care follow-up. Variation persists even in established CVDs and across demographic groups. Longitudinal evaluation is required to determine whether referral heterogeneity influences CV outcomes and prevention effectiveness.CV risks and care gapsPredictors of 'missing' care