Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study

Abstract

Objectives To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.Design Longitudinal nationwide register based cohort study. Setting Main outcome measures Rates of atrial fibrillation and stroke.Results Of 4 182 335 participants included in the cohort, 18 247 were identified as having rheumatoid arthritis during follow-up, with a mean age at disease onset of 59.2 years and a median follow-up of 4.8 years. A total of 156 484 people, including 774 with rheumatoid arthritis, were diagnosed as having atrial fibrillation (age and sex matched event rates of 8.2 per 1000 person years in rheumatoid arthritis patients and 6.0 per 1000 person years in the general population), with an adjusted incidence rate ratio of 1.41 (95% confidence interval 1.31 to 1.51). In addition, 165 343 people, including 718 with rheumatoid arthritis, had a stroke (7.6 per 1000 person years in rheumatoid arthritis and 5.7 per 1000 person years in the general population), with a resultant rate ratio of 1.32 (1.22 to 1.42). For both atrial fibrillation and stroke, relative risks were increased in all strata based on thirds of sex and age, with higher relative risks in younger patients but higher absolute risk differences in older patients.Conclusions Rheumatoid arthritis was associated with an increased incidence of atrial fibrillation and stroke. The novel finding of increased risk of atrial fibrillation in rheumatoid arthritis suggests that this arrhythmia is relevant in cardiovascular risk assessment of these patients.

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

“…Moreover, large population-based studies seem to indicate that also the prevalence of atrial fibrillation is significantly higher in RA subjects than in the general population, suggesting that these patients are characterized by an abnormal diffuse myocardial electrical instability. Although the underlying mechanisms accounting for the pro-arrhythmogenic substrate in RA are probably intricate, the leading role seems to be played by chronic systemic inflammatory activation which is able to promote arrhythmias both indirectly, by accelerating the development of ischemic heart disease and congestive heart failure, and directly, by affecting cardiac electrophysiology [59,60]. Biomarkers associated with heart failure B-type natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP)…”

Atrial Fibrillation Promotion in a Rat Model of Rheumatoid Arthritis

“…Atrial fibrillation (AF) is the most common clinically relevant arrhythmia, with a wide range of potential complications, and contributes significantly to population morbidity and mortality 3. Large population‐based studies indicate that the prevalence of AF is significantly higher in RA patients than in the general population 4, 5, 6. The meta‐analysis of the pooled data from these studies demonstrated ≈30% statistically significant increased risk of AF in RA patients compared with participants without RA 7.…”

Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme

“…Stable exertional angina (go to qn A1.5)1 ACS: Unstable angina 8 (go to qn A1.7) ACS: STEMI 9 (go to qn A1.7)…”

“…moderate limitation 3 Inability to perform any activity without angina or angina at rest, i.e. severe limitation 4 Nuclear myocardial perfusion scan 3 MRI stress perfusion scan 4 Tick the appropriate combination Basal anterior 1 Basal anteroseptal 2 Basal inferoseptal 3 Basal inferior 4 Basal inferolateral 5 Basal anterolateral 6 Mid-anterior 7 Mid-anteroseptal 8 Mid-inferoseptal 9 Mid-inferior 10 Mid-inferolateral 11 Mid-anterolateral 12 Apical anterior 13 Apical Agatston score:…”