BackgroundRheumatic diseases such as rheumatoid arthritis (RA) and Systemic lupus erythematosus (SLE) were known for increased prevalence and risk of death from cardiovascular disease (CVD) due to systemic inflammation in conjunction with other environmental risk factors and genetic predispositions.[1]The COVID-19 pandemic is of the leading causes for the increased age-adjusted mortality rate in 2020 due to various unforeseeable conditions including unequitable healthcare resource distribution, decrease access to medical treatment other than for COVID-19 infection.ObjectivesTo investigate if the presence of the COVID-19 had an impact on the mortality outcome of acute myocardial infraction (AMI) and acute heart failure (AHF) in rheumatic diseases (RDs) including patients with RA, SLE, psoriasis/psoriatic arthritis, gout, myositis and vasculitis, and sarcoidosis in the United States using the NIS inpatient database from 2016-2020.MethodsUsing NIS database from 2016-2020, we identified patients with a primary admission diagnosis of AMI or AHF using ICD-10 codes. For each admission, we calculated ascertained mortality risk. The association of RDs with inpatient mortality was calculated using multivariable logistic regression. Mortality outcomes from 2016-2019 was compared to 2020, which was the year COVID-19 pandemic initiated.ResultsWe identified a total of 691,834 AMI/AHF hospitalizations from 2016-2019, of which 39,047 patients had RDs. During the pre-COVID-19 time, the inpatient mortality was significantly higher in the non-RDs group (4.1% vs 3.3%,p=<0.001). In multivariable logistic regression model, after adjusting for age, race, gender, region, income and confounding comorbidities, patients in the RDs group had a lower odd ratio of inpatient mortality in AMI/AHF compared to non-RDs group (OR=0.71,p=<0.001). During the pandemic year, total AMI/AHF hospitalizations were 121,285, and 5,813 of them were patients had RDs. Again the hospitalization mortality was higher in the non-RDs group with clinical significance ofp= <0.001 (4.8% vs. 3.4%). Interestingly, in terms of the COVID-19 infection rate, patients the non-RDs group had a higher infection rate when comparing to RDs (25% vs 23%,p=0.047). The odd ratio for AMI/AHF hospitalization mortality was again significantly lower in RDs groups compared to non-RD’s group (OR=0.65,p=<0.001).ConclusionBased on our analysis, the presence of co-morbid RDs was not associated with an increased mortality in patients hospitalized with AMI/AHF. These results may be attributed to the use of biologic agents in RDs patients in reducing systemic inflammation. The lower COVID-19 infection rate in RDs patients could be related to the early and aggressive implementation of social distancing and telehealth appointments in the US during the COVID-19 pandemic.Reference[1]Alhusain, A., & Bruce, I. N. (2013). Cardiovascular risk and inflammatory rheumatic diseases. Clinical medicine (London, England), 13(4), 395–397.https://doi.org/10.7861/clinmedicine.13-4-395Table 1.Demographic, Outcomes and Adjusted Odd Ratio of Hospital Mortality of Acute Myocardial Infraction and Acute Heart Failure Exacerbation in Patient Without and With Rheumatic Diseases 2016-2020Characteristics/outcome 2016-2019Without RDs 691,834With RDs* 39,047p-valueCharacteristics/outcome 2020Without RDs 121,285With RDs* 5,813p-valueMortality (%)4.13.3<0.001Mortality4.83.4<0.001Age (Year, mean)6871<0.001Age (Year, mean)6770<0.001Female (%)4135<0.001Female (%)3731<0.001Length of Stay (day)34<0.001Length of Stay (day)33<0.001COVID-19 Infection Rate (%) ¥25230.047Characteristics/outcome 2016-2019Odd Ratio95% CIp-valueCharacteristics/outcome 2020Odd Ratio95% CIp-valueMortality0.71(0.60, 0.83)<0.001Mortality0.65(0.56, 0.76)<0.001Length of Stay1.01(1.01, 1.02)<0.001Length of Stay1.01(1.00, 1.01)<0.001Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundThe pathophysiology of cardiovascular damage in myositis is a multi-factorial process. Myositis can cause inflammation of the myocardium with accelerated coronary atherosclerosis,the risk of cardiovascular disease in hospitalized patients with idiopathic dermatomyositis was 15% from 2016-17.1ObjectivesTo investigate the quality of care of acute myocardial infarctions (AMI) events in myositis compared to non-myositis patients across the United States categorized by the types of hospitals, probability of myocardial events, and mortality outcome from the NIS from 2016-19.MethodsWe used SAS statistical software to perform analyses on the NIS database (2016-19) in the US. Adults with AMI and myositis at the time of discharge were identified by International Statistical Classification of Disease 10 (ICD-10) codes. Latent class analysis was used to empirically identify hospital groups across different regions in the U.S where myositis patients received their cardiac care. Once hospital groups were determined, patients were compared with and without myositis in each hospital group. Probabilities of AMI event and mortality among myositis patients were compared using logistic regression analysis.ResultsThe NIS sample included 38,363 myositis patients and 24,179,176 non-myositis patients. Three hospital groups were identified, the first two represented inner-city hospitals, with the second group of hospitals tending to be larger and serving lower income patients (Table 1). The third hospital group represented rural hospitals, though they also tended to perform fewer cardiac procedures. Importantly, this third group was about half as likely to identify myositis patients and more likely to identify the unrelated confounder conditions. (myositis=0.10%, confounder=41.0%) This provides evidence that rural hospitals may lack the training and resources to properly care for myositis patients, as hypothesized.Table 1.Hospital Characteristics and Patient OutcomesTraitGroup 1Group 2Group 3Group 1Group 2Group 3OverallPatient Diagnoses (%)MI Event (%)Myositis ^0.220.180.10Myositis patients19.0211.319.89Myocardial infarction ±8.977.0210.85Non-myositis patients22.1312.0512.59Unrelated confounder *34.6435.8741.60OR0.860.940.790.83Catheter procedures2.522.390.84p0.0026< 0.0001< 0.0001<0.0001Hospital CharacteristicsMortality (%)Bedsize (1 = small to 3 = large)1.311.361.86Myositis patients6.125.1510.02Rural setting (%)7.080.6437.00Non-myositis patients9.776.828.95Transfers out (%)20.0320.6117.12OR0.630.761.120.60Patient income quartiles (M)2.101.752.12p0.0001< 0.0001< 0.0001< 0.0001^ Based on ICD 10 codes under M33, M60 and G72 groups± Based on ICD 10 codes under I21group* Confounder diagnoses: hypertension, hyperlipidemia, diabetes mellitus, tobacco/alcohol/substance abuses, obesity, rheumatoid arthritis, systemic lupus erythematosus and gout.Overall, the odd ratio (OR) for myositis patients to have AMI event was 0.83 (p < 0.0001); among those who had AMI events, OR for mortality was 0.60 (p < 0.0001). Patients who received care at more rural hospitals (group 3) were at heightened mortality risk (OR=1.12, p < 0.0001). Opposite to the patient experiences in urban hospitals, the unique risk of mortality to myositis patients in rural hospitals was heightened (OR = 1.88, p < 0.0001).ConclusionMyositis was not associated with higher AMI events and mortality outcomes in this nationwide hospitalization cohort. Hospitals in rural locations had fewer diagnosed cases of myositis, catheter procedure and transfer out rate may have contributed to higher AMI mortality outcome in group 3. Further studies should examine if catheter procedure mortality outcome of AMI event in myositis differ in the three hospital groups.References[1]Pavon MR, and et al. Reasons for Hospitalization and In-Hospital Mortality in Adults With Dermatomyositis and Polymyositis.2021 Jun 18. J Clin Rheumatol. 2021;10.1097Disclosure of InterestsNone declared
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