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.
Atherosclerotic Cardiovascular Disease among Hospitalized Dermatomyositis Patients in the US.
Linos3, Eleni, Fiorentino3, David, Lingala3, Bharathi, Krishnan2, Eswar, Chung1, Lorinda
Increasing evidence suggests that atherosclerotic cardiovascular disease is more prevalent among patients with rheumatologic diseases, including rheumatoid arthritis and systemic lupus erythematosus, compared with the general population. Cardiac involvement in patients with dermatomyositis (DM) has been reported and is associated with a poor prognosis, but the prevalence of atherosclerotic cardiovascular disease is unknown. Our aim was to evaluate the prevalence of atherosclerotic cardiovascular comorbidities and their associated mortality risk among hospitalized DM patients in the US.
We examined the in-hospital frequency and mortality rates of specific diagnoses and procedures associated with atherosclerotic cardiovascular disease among hospitalized adult patients with DM using data from the Nationwide Inpatient Sample (NIS) from 1993 to 2007. The NIS is a national, annual, representative survey of hospitalized patients in the US. The following diagnoses and procedures were identified by ICD-9 codes: coronary artery disease, congestive heart failure, angina, myocardial infarction, and cerebrovascular accidents; coronary artery bypass grafts, coronary catheterization, and percutaneous transluminal coronary angioplasty. We compared the odds of death among hospitalized DM patients with each cardiovascular diagnosis or procedure to those without using logistic regression. Analyses were weighted so results are standardized to the US population as a whole.
A total of 50,323 hospitalizations of DM patients occurred in the US between 1993 and 2007. The mean patient age was 58 years, and 73% of patients were female. Of all DM hospitalizations, 20% were associated with a concurrent atherosclerotic cardiovascular diagnosis or procedure. The overall in-hospital mortality rate was 57 per 1000. DM patients with any of the specified atherosclerotic cardiovascular diagnoses or procedures were twice as likely to die during the inpatient stay compared to DM patients who did not have atherosclerotic cardiovascular disease (OR=2.0 95% CI 1.72.5, p<0.0001). The highest odds of death were noted for patients with congestive heart failure (OR=2.3 95% CI 1.92.8, p<0.001) and cerebrovascular accidents (OR=2.3 95% CI 1.73.3, p<0.001).
In this large US-based hospitalization database, approximately one fifth of hospitalizations in DM patients were associated with an atherosclerotic cardiovascular diagnosis or procedure. These patients have double the risk of in-hospital death, making identification of these groups important for both prognostic purposes and clinical care. Further prospective studies are necessary to confirm our findings and to analyze the relative contribution of disease activity, concomitant risk factors, and corticosteroid treatment.
To cite this abstract, please use the following information:
Linos, Eleni, Fiorentino, David, Lingala, Bharathi, Krishnan, Eswar, Chung, Lorinda; Atherosclerotic Cardiovascular Disease among Hospitalized Dermatomyositis Patients in the US. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1378