Background Data indicate that rheumatoid arthritis (RA) is associated with a poorer short- and long term outcome, in terms of case-fatality, after acute coronary events (ACS), and that this might be due to suboptimal institution of secondary preventive drugs.
Objectives To assess whether case-fatality after ACS differs in prevalent RA-patients compared to the general population, and to investigate whether any difference could be linked to a variation in initiation and/or adherence to standard of care cardioprotective secondary preventive drugs (Aspirin, P2Y12-inhibitors, RAS-blockers, β-blockers and statins).
Methods Using the Swedish nationwide patient registry, a cohort of 31890 individuals with prevalent RA 2008 was identified. This RA-cohort and 163045 general population comparators matched on sex, year of birth, area of residency and educational level were followed through 2008 to identify all cases hospitalized with an incident ACS. After the ACS, information on all-cause, cause-specific mortality and dispensed drugs of interest was collected during a follow-up of 390 days. Cox regression models, adjusted for potential imbalances in demographics and preexisting comorbidities/pharmacotherapies as a propensity score, were used to analyze mortality.
Results 261 (0.8%) of the RA-patients and 729 (0.4%) of the general population comparators suffered an ACS during 2009. Of the individuals with an ACS, a higher proportion of RA-patients was diagnosed with a transmural myocardial infarction (25% vs. 20%) and was hospitalized for more than 5 days (30% vs. 25%). A higher proportion of RA-patients compared to comparators received primary reperfusion therapy (42% vs. 28%), whereof 34% (vs. 25%) received PCI and 6% (vs 1%) received CABG. The case-fatality was more than twice as high among the RA-patients compared to the comparators during the month following the event. 11% (vs. 4%) died within the first week, and 15% (vs. 7%) during the first 30 days. During the entire follow-up of 390 days, 27% of the RA-cases (vs. 15%) died. This corresponded to adjusted hazard ratios between 2.7-2.0 (Figure). There was no significant difference in initiation and/or adherence to any of the studied secondary preventive drugs. 74% of both RA-patients and comparators initiated a combination of at least 3 drugs. 50% of RA-patients (vs 55%) adhered to at least 3 drugs at 1 year after the event (p=0.26).
Conclusions In this study of acute coronary syndrome in patients with prevalent RA, the acute coronary events were on average somewhat more serious, the case fatality was higher, but the initiation and adherence to secondary preventive drugs were similar compared to general population.
Disclosure of Interest None declared