Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Hospitalizations Following Heart Failure Diagnosis in Rheumatoid Arthritis Patients.
S. Crowson, Cynthia, M. Davis III, John, L. Roger, Veronique, L. Matteson, Eric, M. Therneau, Terry, E. Gabriel, Sherine
Patients with rheumatoid arthritis (RA) suffer from an excess burden of cardiovascular disease, especially heart failure (HF). In addition, RA patients have a higher mortality rate following HF diagnosis compared to patients without RA. Hospitalizations in patients with HF are a major public health problem. The purpose of our study was to compare the rate of hospitalizations and length of stay after HF diagnosis in patients with and without RA.
A population-based inception cohort of RA subjects who fulfilled 1987 ACR criteria for RA and subsequently developed HF (Framingham diagnostic criteria) between 1-67-1987 and 7-67-2008 was assembled and compared to an age, sex and calendar year matched (3:1) sample of HF patients without RA from the same population. Patients in both groups were followed until death, migration, or 1-67-2010 and all hospital admission and discharge dates were obtained. Person-year methods were used to estimate hospitalization rates. Andersen-Gill models, a modification of Cox models accounting for multiple hospitalizations per patient, were used to compare hospital admission rates between the groups.
The study included 548 HF patients (137 with RA and 411 non-RA). Both groups had mean age of 77 (s.d. 10) years with 64% women. The RA patients were followed up for a mean of 3.9 years (528 person-years) after which the majority (83%) were deceased; similarly for the non-RA patients the mean follow-up was 4.8 years (1991 person-years)and 72% died. During this time RA patients experienced a higher rate of hospitalization (1.09 hospitalizations per year compared to 0.88 per year for non-RA; p<0.001). Thus, RA patients experienced 20% more hospitalizations (hazard ratio: 1.2; 95% confidence interval: 1.01, 1.5; p=0.038) compared to non-RA patients In addition the length of stay per hospitalization was on average 0.66 days longer for the RA patients compared to the non-RA patients (p=0.025). Significant independent predictors of hospitalization among patients with RA and HF include male gender, duration of RA, ischemic heart disease, diabetes, comorbidities (cerebrovascular disease, ulcers, renal disease, and cancer). In addition, steroid users were more likely to be hospitalized, even after adjusting for all other significant predictors (hazard ratio: 1.4; 95% CI: 1.03, 1.8; p=0.03).
Patients with RA and HF have a higher rate of hospitalization than HF patients without RA and they experience longer hospital stays. A complex constellation of comorbidities and other factors, including steroid use, are associated with the risk of hospitalization for RA patients with HF. More research is needed to improve the outcomes for RA patients with HF.
To cite this abstract, please use the following information:
S. Crowson, Cynthia, M. Davis III, John, L. Roger, Veronique, L. Matteson, Eric, M. Therneau, Terry, E. Gabriel, Sherine; Hospitalizations Following Heart Failure Diagnosis in Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :67