Postoperative Major Adverse Cardiac Events in Patients With Systemic Lupus Erythematosus

Abstract

Objectives Patients with systemic lupus erythematosus (SLE) have a high risk of cardiovascular disease that could potentially increase postoperative major adverse cardiac events (MACE). We determined the rate of MACE in patients with SLE undergoing noncardiac surgery using national claims‐based data. Methods This was a retrospective cohort study using Optum Clinformatics Data Mart from 2007 to 2020. We identified a cohort of patients with SLE who had undergone noncardiac surgeries using Current Procedural Terminology codes. We also identified two control cohorts without SLE, one with diabetes mellitus (DM) and one without DM. After matching cases and controls by age and sex, the odds of MACE were estimated using multivariable logistic regression models also including race and the Revised Cardiac Risk Index (RCRI) scores. We also examined use of preoperative cardiac testing. Results We identified 4750 patients with SLE, 496,381 DM controls, and 1,484,986 non‐DM controls. After matching, the odds ratio (OR) for MACE in patients with SLE versus non‐DM controls was 1.51 (95% confidence interval 1.09‐2.08), which decreased after adjustment for RCRI score (OR: 0.97, 95% confidence interval 0.7‐1.36). No significant differences were observed in the incidence of MACE between patients with SLE and DM controls (0.82 vs 1.04, P = 0.16). High‐risk patients with SLE (RCRI score of ≥3) were less likely to receive preoperative cardiac testing than non‐DM controls (42.7% vs 35.1%, P < 0.05). Conclusion Patients with SLE have an increased risk of postoperative MACE, which is driven by increased RCRI scores. Concerningly, high‐risk patients received less cardiac testing 2 months before surgery than non‐DM controls.

Home‐Based Telemedicine in Rheumatology—A Scoping Review

“…Although these data suggest concerns for care quality via telehealth for patients with SLE and IA, a retrospective analysis from a large Texas health care system reported that lupus patients with lower socioeconomic status missed fewer telehealth appointments compared with F2F visits, indicating that telehealth options may maintain attendance, an aspect of care quality. 17 Taken together, these studies suggest that telehealth may be less suitable for new patients with possible IA or autoimmune CTD, although it may be suitable to enhance continuity of care during follow‐up of patients with IA and SLE and may also be appropriate to provide osteoporosis care. 13 , 14 …”

“…Two were prospective cohort studies from Italy 11 and the US, 12 and five were retrospective studies from the UK, 13 , 14 Australia, 15 and the US. 16 , 17 All were single‐center studies conducted after March 2020. The optimal screening method for telehealth visit appropriateness was addressed in two studies.…”

“…The lack of a physical examination to assess disease severity was also a concern in the three previous systematic reviews. [7][8][9] However, in our review, several studies 15,17 indicated that patients with these conditions, even with serious manifestations such as lupus nephritis, may be adequately managed through telehealth in the short term, especially if it improves access to care for patients with transportation limitations or other restrictions. Although additional research on telehealth suitability needs to be conducted, interim measures could include prioritizing telehealth for follow-up visits and conditions such as osteoporosis and perhaps gout, for which biomarker-based decision-making is acceptable.…”