Abstract
Objective. To investigate the incidence of atrial fibrillation (AF) among patients with rheumatoid arthritis (RA) compared to the general population. Methods. A population-based inception cohort of Olmsted County, Minnesota, residents with incident RA in 1980–2007 and a cohort of non-RA subjects from the same population base were assembled and followed until 12/31/2008. The occurrence of AF was ascertained by medical record review. Results. The study included 813 patients with RA and 813 non-RA subjects (mean age 55.9 (SD:15.7) years, 68% women in both cohorts). The prevalence of AF was similar in the RA and non-RA cohorts at RA incidence/index date (4% versus 3%; P = 0.51). The cumulative incidence of AF during follow-up was higher among patients with RA compared to non-RA subjects (18.3% versus 16.3% at 20 years; P = 0.048). This difference persisted after adjustment for age, sex, calendar year, smoking, and hypertension (hazard ratio: 1.46; 95% CI: 1.07, 2.00). There was no evidence of a differential impact of AF on mortality in patients with RA compared to non-RA subjects (hazard ratio 2.5 versus 2.8; interaction P = 0.31). Conclusion. The incidence of AF is increased in patients with RA, even after adjustment for AF risk factors. AF related mortality risk did not differ between patients with and without RA.
Highlights
Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease associated with an increased risk of cardiovascular disease and premature mortality [1, 2]
Cardiovascular risk factors at RA incidence date/index date were similar in both cohorts except for a higher prevalence of smokers among the RA patients compared to the non-RA subjects (P = 0.002; Table 1)
There was no difference in the prevalence of atrial fibrillation (AF) at RA incidence/index date among patients with RA compared to non-RA subjects (n = 33, 4% versus n = 28, 3%), P = 0.51
Summary
Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease associated with an increased risk of cardiovascular disease and premature mortality [1, 2]. The primary research focus in vascular disease in patients with RA has been on coronary heart disease. Recent publications have examined the relationship between atrial fibrillation (AF) and RA with variable results [3, 4]. Prevalence, and mortality impact of AF in a population-based inception cohort of patients with RA and a comparator population from the same community
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