Cardiovascular admissions and mortality in an inception cohort of patients with rheumatoid arthritis with an onset in the 1980's and 1990's

Nicola Jane Goodson ¹, Jeffrey Marks ², Mark Lunt ³ and Deborah P.M. Symmons ^3*

¹ Liverpool University, United Kingdom
² Stepping Hill Hospital, United Kingdom
³ ARC Epidemiology Unit, Manchester University, United Kingdom

^* To whom correspondence should be addressed. E-mail: deborah.symmons{at}man.ac.uk.

Accepted 6 April 2005

Abstract

Background: Rheumatoid arthritis (RA) patients have increased cardiovascular disease (CVD) mortality. However, studies have suggested RA survival may have improved over recent decades. Excess CVD mortality may be due to an increased prevalence of CVD or to an increased case fatality in RA patients.

Objectives: To examine whether RA patients with disease onset in the 1980s-1990s have increased mortality rates and to compare cardiovascular admission rates in RA patients with those of the general population.

Methods: An inception cohort of 1010 RA patients attending Stockport rheumatology clinics between 1981 and 1996 was followed up to 31st December 2002 via the Office for National Statistics (ONS). Standardised mortality ratios (SMR) were calculated for all cause and cause specific mortality using the population of Stockport as the reference. CVD admission rates were ascertained for a subgroup of these patients, using national hospital episode statistics, and standardised CVD admission rates (SAR) and SMRs were calculated for this subgroup.

Results: 470 (48%) patients died during a median follow-up period of 11.4 years. All cause mortality was increased in men: (SMR 1.45 (95% 1.22, 1.71)); and women: (SMR1.84; (95% CI 1,64, 2.05)), as was CVD mortality, men: (SMR 1.36 (95% CI 1.04, 1.75); and women: (SMR 1.93 (95%CI 1.65, 2.26)). No difference in CVD admission rates was observed in men: (SAR 1.20 (95% CI 0.89, 1.58); or women: (SAR 1.10 (95% CI 0.88, 1.36)) despite excess CVD mortality in this subgroup.

Conclusion: RA patients still experience reduced life expectancy and excess CVD mortality. Despite this, standardised admission rates for CVD were not raised. This suggests either that CVD in RA has a higher case fatality than the general population or that it is frequently unrecognised in RA patients prior to the fatal event.

Keywords: Admission rates, Cardiovascular, Mortality, Rheumatoid arthritis

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