Baker, Joshua

Cannon, Grant W.

England, Bryant

Johnson, Tate

Mikuls, Ted

Roul, Punyasha

Sauer, Brian

Sayles, Harlan

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Volume 2 Issue 1 Article 19 September 2020 Methotrexate Is Associated With Reduced Cardiovascular Risk in U.S. Veterans With Rheumatoid Arthritis Independent of Disease Activity Modification Tate Johnson et al Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Johnson et al, T. Methotrexate Is Associated With Reduced Cardiovascular Risk in U.S. Veterans With Rheumatoid Arthritis Independent of Disease Activity Modification. Graduate Medical Education Research Journal. 2020 Sep 29; 2(1). https://digitalcommons.unmc.edu/gmerj/vol2/iss1/19 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Methotrexate Is Associated With Reduced Cardiovascular Risk in U.S. Veterans With Rheumatoid Arthritis Independent of Disease Activity Modification Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol2/iss1/19 Sept. 2020  |  Vol. 2  |  Issue 1 Oral Presentations 31*Names in bold type indicate presenting author.Methotrexate Is Associated With Reduced Cardiovascular Risk in U.S. Veterans With Rheumatoid Arthritis  			Tate Johnson1, Joshua Baker2, Punyasha Roul1, Harlan Sayles1, Grant W. Cannon3, Brian Sauer3, Ted Mikuls1, Bryant England11 University of Nebraska Medical Center, Department of Internal Medicine, Division of Rheumatology  2University of Pennsylvania, Department of Internal Medicine, Division of Rheumatology 3 University of Utah, Department of Internal Medicine, Division of RheumatologyMentor: Bryant R. EnglandProgram: Internal Medicine, Division of RheumatologyType: Original ResearchBackground: Rheumatoid arthritis (RA) patients are at increased risk of cardiovascular disease (CVD). Methotrexate, a mainstay in RA treatment, appears to mitigate this 					unclear.Methods: We observed a cohort of Veterans with RA for incident CVD from 4/2005 to 4/2015. A composite of acute myocardial infarction (AMI), coronary revascularization, stroke, and heart failure hospitalization data and validated by medical record review. Baseline and time-varying covariates were assessed using registry and administrative 	!by linkage with pharmacy dispensing data. Marginal structural models, incorporating time-varying confounders into the propensity to receive methotrexate, were used to assess the association of methotrexate with CVD. To examine whether association of methotrexate with CVD was mediated through disease "#$models including post-methotrexate disease activity. Results: Over 9,490 person-years of follow up, incidence of composite CVD events (n=357) was lower in methotrexate-exposed patients (incidence rate ratio 0.82). In marginal structural models, methotrexate was associated with reduced risk of composite %&	'*+6:;<+0.40). In sequential Cox models, adjustment for post-methotrexate disease activity did not $	%&>HR -0.03 to 0.01). Conclusion: Methotrexate was associated with reduced composite CVD and CHF, !"of RA disease activity was not a primary driver of lower CVD risk, suggesting a $"$	that should be considered when modifying treatment regimens in RA patients. https://doi.org/10.32873/unmc.dc.gmerj.2.1.018Factors Affecting Emergency Medicine Residency Applicant Perceptions of Competitiveness and Number  of Applications SubmittedErin Karl1, Zach Jarou2, Chichen Qiu3, Aaron Barksdale1 1 University of Nebraska Medical Center, Department of Emergency Medicine  2University of Chicago, Section of Emergency Medicine, Chicago, IL 3Stanford University, Department of Emergency Medicine, Stanford, CAMentor: Aaron BarksdaleProgram: Emergency MedicineType: Original ResearchBackground: Applicants to emergency medicine (EM) residency applied to an average of 56.6 programs each in 2018, more than double the number compared to one decade ago. Methods: Fourth-year medical students (n=132) attending the Emergency Medicine Residents’ Association Medical Student 	<:@GJK$"asked to complete a 24 question survey. Response rate was 80.2%. Students who were IMGs, couples or military matching, had not taken Step 1, or had not completed or received their grade from at least one EM rotation were excluded (leaving n=72). Descriptive and summary statistics were used.Results: The median Step 1 score was 226.3, and 15.9% were AOA. Students were 61.1% MD and 38.9% DO. Step 1 scores decreased perceptions of competitiveness for 53%, while increasing perception in 35%. Feedback from EM mentors and rotations (75% and 71%), leadership and extracurricular activities (67% and 66%), and Standardized Letter of Evaluation (SLOE) strength (65%) contributed to increased perception of competitiveness (Figure 1). The most common factors increasing applications submitted included; EM is becoming more competitive (83%), lack of SLOE transparency (70%), belief they are less competitive than the average applicant (69%), or unsure about their competitiveness (66%).Conclusions: Step 1 scores caused more than half of applicants to decrease their perception of competitiveness. Feedback from EM mentors and EM rotations increased applicants’ perception of competitiveness. The top three factors increasing residency applications were the belief that EM is becoming more competitive, lack of SLOE transparency, and an applicant’s belief that they are less competitive. https://doi.org/10.32873/unmc.dc.gmerj.2.1.019Figure 1. Factors that changed applicants’ self-perception of competitiveness. (n=72)

Methotrexate Is Associated With Reduced Cardiovascular Risk in U.S. Veterans With Rheumatoid Arthritis Independent of Disease Activity Modification

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Methotrexate Is Associated With Reduced Cardiovascular Risk in U.S. Veterans With Rheumatoid Arthritis Independent of Disease Activity Modification

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