RESEARCH - Increased fatality rates following a first acute cardiovascular even in patients with RA

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Arthritis Rheum. 2006 Jun 26;54(7):2061-2068 [Epub ahead of print]

Increased case fatality rates following a first acute cardiovascular event

in patients with rheumatoid arthritis.

Van Doornum S, Brand C, King B, Sundararajan V.

University of Melbourne, and Royal Melbourne Hospital, Melbourne, ,

Australia.

OBJECTIVE: Among patients with rheumatoid arthritis (RA), cardiovascular

mortality is increased compared with the rate among unaffected peers. In

this study, 30-day mortality rates following a first acute cardiovascular

event (myocardial infarction or stroke) were compared between RA patients

and the general population. METHODS: All cases of a first acute

cardiovascular event between July 1, 2001 and November 30, 2003 in ,

Australia were identified from hospital discharge data. Individuals were

classified as having RA when an International Classification of Diseases,

Ninth Revision, Clinical Modification (ICD-9-CM) or an International

Statistical Classification of Diseases and Related Health Problems, Tenth

Revision, Australian Modification code for RA was recorded at the index

admission or during the previous 5 years. Thirty-day mortality rates were

determined from linkage to the state death registry. RESULTS: A total of

29,924 patients experienced a first cardiovascular event during the study

period, 359 (1.2%) of whom had RA. Thirty-day cardiovascular mortality was

17.6% in RA patients versus 10.8% in non-RA patients. In fully adjusted

models, the odds ratio (OR) for cardiovascular death in RA patients

following a first acute cardiovascular event was 1.6 (95% confidence

interval [95% CI] 1.2-2.2). Analysis of index event subgroups revealed that

this increased case fatality rate in patients with RA was accounted for

almost entirely by excess deaths following myocardial infarction. The

adjusted ORs for cardiovascular death in RA after myocardial infarction and

stroke were 1.9 (95% CI 1.3-2.7) and 1.2 (95% CI 0.7-2.0), respectively.

CONCLUSION: RA patients have a substantially increased risk of 30-day case

fatality following myocardial infarction, but not stroke, compared with

non-RA patients. This higher case fatality rate is likely to contribute to

the observed overall excess of cardiovascular deaths in RA populations.

PMID: 16802340

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6802340 & dopt=Abstract

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