Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2021; 9(14): 3252-3264
Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3252
Burden of atrial fibrillation in patients with rheumatic diseases
Muhammad Zubair Khan, Kirtenkumar Patel, Krunalkumar A Patel, Rajkumar Doshi, Vraj Shah, Devina Adalja, Zainulabedin Waqar, Sona Franklin, Neelesh Gupta, Muhammad Hamdan Gul, Shruti Jesani, Steven Kutalek, Vincent Figueredo
Muhammad Zubair Khan, Krunalkumar A Patel, Sona Franklin, Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
Kirtenkumar Patel, Division of Cardiology, North Shore University Hospital, Manhasset, NY 11030, United States
Rajkumar Doshi, Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89502, United States
Vraj Shah, Division of Cardiology, Medical College of Baroda, Baroda 390001, India
Devina Adalja, Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 390021, India
Zainulabedin Waqar, Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, United States
Neelesh Gupta, Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA 19115, United States
Muhammad Hamdan Gul, Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL 60657, United States
Shruti Jesani, Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ 07202, United States
Steven Kutalek, Vincent Figueredo, Department of Cardiology, St. Mary Medical Center, Langhorne, PA 19047, United States
Author contributions: Khan MZ, Patel K, Patel KA, Kutalek S, Figueredo V designed the research study; Doshi R, Patel K, Shah V, Waqar Z performed the research; Adalja D, Franklin S, Gupta N, Gul MH, and Jesani S analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study cohort was derived from a de-identified and publicly available database; hence, the study was considered exempt from formal approval of the Institutional review board.
Informed consent statement: We used Nationwide Inpatient Sample database for our study. Our database does not contain information of patient’s identity. So, the informed consent is not required.
Conflict-of-interest statement: All other authors have nothing to disclose.
Data sharing statement: Statistical code and dataset available from the corresponding author.
STROBE statement: The authors have read the STROBE Statement-a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vincent Figueredo, FACC, FAHA, Assistant Professor, Department of Cardiology, St. Mary Medical Center, 1203 Langhorne-Newtown Road, Suite 320, Langhorne, PA 19047, United States. vincent.figueredo@stmaryhealthcare.org
Received: January 7, 2021
Peer-review started: January 7, 2021
First decision: January 18, 2021
Revised: February 6, 2021
Accepted: March 19, 2021
Article in press: March 19, 2021
Published online: May 16, 2021
Processing time: 111 Days and 17.3 Hours
Abstract
BACKGROUND

Studies have suggested that atrial fibrillation (AF) in patients with rheumatic diseases (RD) may be due to inflammation.

AIM

To determine the highest association of AF among hospitalized RD patients and to determine morbidity and mortality associated with AF in hospitalized patients with RD.

METHODS

The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF. A subgroup analysis was performed comparing outcomes of AF among different RD.

RESULTS

The prevalence of AF was 23.9% among all patients with RD (n = 3949203). Among the RD subgroup, the prevalence of AF was highest in polymyalgia rheumatica (33.2%), gout (30.2%), and pseudogout (27.1%). After adjusting for comorbidities, the odds of having AF were increased with gout (1.25), vasculitis (1.19), polymyalgia rheumatica (1.15), dermatopolymyositis (1.14), psoriatic arthropathy (1.12), lupus (1.09), rheumatoid arthritis (1.05) and pseudogout (1.04). In contrast, enteropathic arthropathy (0.44), scleroderma (0.96), ankylosing spondylitis (0.96), and Sjorgen’s syndrome (0.94) had a decreased association of AF. The mortality, length of stay, and hospitalization costs were higher in patients with RD having AF vs without AF. Among the RD subgroup, the highest mortality was found with scleroderma (4.8%), followed by vasculitis (4%) and dermatopolymyositis (3.5%).

CONCLUSION

A highest association of AF was found with gout followed by vasculitis, and polymyalgia rheumatica when compared to other RD. Mortality was two-fold higher in patients with RD with AF.

Keywords: Atrial fibrillation; Rheumatic diseases; Lupus; Gout; Scleroderma; Vasculitis

Core Tip: Current study showed an association of atrial fibrillation in rheumatic disease patients. We found that atrial fibrillation is significantly associated with gout followed by vasculitis and polymaylgia rheumatica. Overall mortality, length of stay and hospitalization cost was higher among rheumatic disease patients with atrial fibrillation.