Medstar Georgetown University hospital Arlington, Virginia, United States
Disclosure(s): No financial relationships with ineligible companies to disclose
Background/Purpose: The increased risk of cardiovascular morbidity and mortality with rheumatoid arthritis has been increasingly acknowledged over the past decades. Cardiovascular disease risk management for patients with rheumatoid arthritis is essential. This retrospective population-based study investigated in-hospital outcomes among adult patients admitted with acute myocardial infarction (AMI), with a specific focus on the impact of rheumatoid arthritis (RA) on these outcomes. Methods: Data was derived from the National Inpatient Sample (NIS) database, between January 1, 2018and December 31, 2021, encompassing a large and diverse cohort of hospitalized individuals. The primary outcome analyzed was in-hospital mortality, with secondary outcomes being the utilization of diagnostic angiography, rates of percutaneous coronary intervention (PCI), and the incidence of complications such as acute kidney injury (AKI), cardiogenic shock, cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), as well as requirements for mechanical ventilation, tracheal intubation, and mechanical circulatory support (MCS). Additional parameters examined were length of stay (LOS) and total hospitalization charges.
The study population comprised of 2,275,150 patients, predominantly Caucasian (71%), followed by African American patients (11%), with females representing 36.4% of the cohort. The mean age across the population was 66.5 years (±2.8 years). Among these patients, 39,270 (1.7%) had a documented history of rheumatoid arthritis. Owing to the significant difference in sample size between patients with AMI in the presence and absence of RA, a propensity score matching (PSM) algorithm was employed to generate comparable groups. Post-matching, 15,703 patients from each cohort were selected, ensuring a similar distribution of age, sex, race, and Charlson Comorbidity Index score. Results: Comparative analysis of the matched cohorts revealed notable differences in outcomes. Patients with RA experienced a lower rate of in-hospital mortality (3.8% vs. 4.8%, P < 0.001) compared to those without RA. Additionally, the utilization of mechanical circulatory support was lower in the RA group (2.9% vs. 4.2%). In contrast, the RA cohort demonstrated higher rates of diagnostic angiography (74% vs. 71%, P < 0.001) and PCI (48% vs. 44%), suggesting a more aggressive diagnostic and interventional approach. Conclusion: The study highlights that despite previous associations of rheumatoid arthritis with increased mortality largely due to cardiovascular complications, advancements in disease management and therapeutic interventions may have contributed to improved in-hospital outcomes in this subgroup. The observed higher utilization of diagnostic and interventional procedures in the RA group may reflect heightened clinical vigilance and a lower threshold for invasive testing in this high-risk population. Overall, these findings underscore the importance of continued physicain and pateint education, along with implementation of preventive strategies, to optimize outcomes in patients with Rheumatoid arthritis.
