Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Treatment and Mortality After Myocardial Infarction in Rheumatoid Arthritisa Cohort Study of Incident Rhematoid Arthritis in Sweden.

Holmqvist1,  Marie, Mantel1,  ängla, Jernberg2,  Tomas, Jacobsson3,  Lennart TH, Alfredsson4,  Lars, James5,  Stefan, Askling1,  Johan

Clinical Epidemiology Unit, Dept of Medicine, Karolinska Institutet, Solna, Sweden
Department of medicine, Section of Cardiology, Karolinska University Hospital, Huddinge, Sweden
Section of Rheumatology, Malmo, Sweden
Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
Department of Cardiology, Uppsala University Hospital


To investigate whether RA-patients are at increased risk of dying after an MI and whether level of care and treatment intensity differs between RA-patients and general population comparators after an event.


RA-patients included in the Swedish Rheumatology Quality Register (SRQ) between 1 Jan 1995 and 1 Jan 2007 who had a symptom duration <=12months when included and were free from ischemic heart disease prior to inclusion were matched on sex, calendar period, county, and age to an ischemic heart disease free general population comparator. 6,735 RA-patients and 33,692 general population comparators were identified. An index date was assigned to all individuals; date of inclusion in SRQ in RA and corresponding in comparators. Information on all first time hospitalizations for MI and on all who for the first time were treated in intensive coronary care units (ICCU) after index date was retrieved from Swedeheart, a nationwide register of all ICCU care given in Sweden, and the Swedish Inpatient register. Information on deaths was retrieved from the census register. To compare the risk of death after event, Cox models were constructed using time since event as time scale, adjusted for age and sex. Survival curves were fitted using the product limit estimator.


70% of the RA-patients and comparators were women. Mean age at index date was 57 in RA and comparators. 8% of RA-patients and 6.6% of the comparators were hospitalized with an MI after index date. 41% of RA-patients and 31% of the comparators hospitalized with an MI were treated in an ICCU. Of those hospitalized in an ICCU, there was no difference in the proportion of RA-patients and comparators undergoing coronary bypass surgery or percutaneous coronary interventions. The proportion of individuals prescribed with beta-blocking agents (85%), statins (66%), and nitrates (17 vs 21%) at discharge was similar in the two groups. Oral anticoagulants and antiplatelet medications were somewhat more common in RA-patients at discharge (56.5% vs 49.8%, p non-significant). 63.5% of RA-patients and 65.7% of comparators were assigned followup in a cardiology or internal medicine department. Overall survival after being hospitalized with an MI was similar in RA-patients and comparators (fig 1), RR 1.0 (95% CI 0.7, 1.3). 28-day survival and 1-year survival was also similar in the two groups.


In Sweden, patients with early RA who suffer an MI are as well treated and as likely to survive as the general population.

To cite this abstract, please use the following information:
Holmqvist, Marie, Mantel, ängla, Jernberg, Tomas, Jacobsson, Lennart TH, Alfredsson, Lars, James, Stefan, et al; Treatment and Mortality After Myocardial Infarction in Rheumatoid Arthritisa Cohort Study of Incident Rhematoid Arthritis in Sweden. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1154

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