2240: Diabetes Significantly Amplifies Risk of Cardiac Arrhythmias in Rheumatoid Arthritis Patients: Results from a Multi-Center Electronic Health Record Study

Background/Purpose: Both rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) are independently associated with increased cardiovascular risk. However, the impact of T2DM on cardiac arrhythmia development specifically in patients with RA remains poorly understood.

Methods: We conducted a retrospective cohort study using the TriNetX global federated health research network, analyzing electronic health records from 100 healthcare organizations. We identified patients aged 18-99 years with RA (ICD-10 M06.9) with and without T2DM (ICD-10 E11). After propensity score matching for demographic factors and relevant comorbidities, we compared 129,630 patients in each cohort. Patients were followed for up to 5 years to assess arrhythmia-related outcomes.

Results: Patients with both RA and T2DM demonstrated significantly increased risk of atrial fibrillation (HR 1.93, 95% CI 1.88-1.98, p< 0.001) compared to patients with RA alone. Similarly, the risk for ventricular arrhythmias was substantially higher, with a hazard ratio of 2.18 (95% CI 2.05-2.32, p< 0.001) for ventricular tachycardia and 2.72 (95% CI 2.46-3.01, p< 0.001) for ventricular fibrillation. The comorbid group also demonstrated a 2.11-fold increased risk (95% CI 1.94-2.29, p< 0.001) for sick sinus syndrome and required significantly more pacemaker implantations (HR 2.65, 95% CI 2.50-2.80, p< 0.001).

Conclusion: The presence of T2DM in patients with RA is associated with a substantial increase in risk for multiple cardiac arrhythmias. Our findings suggest that patients with both RA and T2DM should undergo more intensive cardiac monitoring and may benefit from early interventions to prevent arrhythmia development. These results highlight the importance of integrated care across specialties for patients with these comorbid conditions.