S Van Doornum1, C Brand, B King, V Sundararajan. 1. Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Post Office Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia. svd@unimelb.edu.au
Abstract
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 Victoria, 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.
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 RApatients and the general population. METHODS: All cases of a first acute cardiovascular event between July 1, 2001 and November 30, 2003 in Victoria, 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 RApatients versus 10.8% in non-RApatients. In fully adjusted models, the odds ratio (OR) for cardiovascular death in RApatients 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:RApatients have a substantially increased risk of 30-day case fatality following myocardial infarction, but not stroke, compared with non-RApatients. This higher case fatality rate is likely to contribute to the observed overall excess of cardiovascular deaths in RA populations.
Authors: Sara S McCoy; Cynthia S Crowson; Hilal Maradit-Kremers; Terry M Therneau; Veronique L Roger; Eric L Matteson; Sherine E Gabriel Journal: J Rheumatol Date: 2013-02-15 Impact factor: 4.666
Authors: Paul A MacMullan; Anne M Madigan; Nevin Paul; Aaron J Peace; Ahmed Alagha; Kevin B Nolan; Geraldine M McCarthy; Dermot Kenny Journal: Clin Rheumatol Date: 2014-09-26 Impact factor: 2.980
Authors: Sharon Van Doornum; Caroline Brand; Vijaya Sundararajan; Andrew E Ajani; Ian P Wicks Journal: Arthritis Res Ther Date: 2010-10-07 Impact factor: 5.156