Atrial Fibrillation Screening for RA Patients Preliminary

A review of literature on the frequency of atrial fibrillation in patients with rheumatoid arthritis confirms a statistically significant increased risk of atrial fibrillation in patients with rheumatoid arthritis.

The systematic review and meta-analysis was published online on Dec. 22 in the International Journal of Rheumatic Diseases.

The review is based on the results of three retrospective cohort studies with 39,912 cases of rheumatoid arthritis and 4,269,161 controls. The authors found a risk ratio of developing atrial fibrillation as compared to the controls as 1.29 (95% CI, 1.05–1.59). The statistical heterogeneity was moderate with an I2 of 71%.[[{"type":"media","view_mode":"media_crop","fid":"44910","attributes":{"alt":"@SFamPhoto/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_3978438966441","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5066","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"@SFamPhoto/Shutterstock.com","typeof":"foaf:Image"}}]]

​The association between an increased prevalence of cardiovascular disease and of rheumatoid arthritis has been well established with one recent study assessing risk for myocardial infarction and cerebrovascular accident 68 and 41 percent, respectively.  It was presumed that rheumatoid arthritis patients are also at increased risk of atrial fibrillation, but it was never clearly shown in epidemiological studies.

Led by Patompong Ungprasert, M.D., of Mayo Clinic in Minnesota, researchers searched published studies in Medline and Embase. The review includes studies that reported relative risk, hazard ratio, incidence ratio or standardized incidence ratio with 95% confidence intervals comparing the risk of incidence of atrial fibrillation in patients with and without rheumatoid arthritis. They found 731 potentially relevant studies, but narrowed the analysis down to three relevant studies.

There are a few possible reasons for an increased risk of atrial fibrillation in rheumatoid arthritis patients, the authors write:

• The association might be non-causal and merely the result of confounding factors, such as smoking, which predisposes patients to rheumatoid arthritis.
• Coronary artery disease and congestive heart failure are more prevalent among patients with rheumatoid arthritis and are risk factors for atrial fibrillation.
• Inflammation associated with rheumatoid arthritis could play a role.

Despite evidence for the development of atrial fibrillation in patients with rheumatoid arthritis, Dr. Ungprasert and colleagues say it may be preliminary to institute routine screening for atrial fibrillation as part of the cardiovascular assessment for rheumatoid arthritis patients.

References:

Patompong Ungprasert, Narat Srivali and Wonngarm Kittanamongkolchai.

"Risk of incident atrial fibrillation in patients with rheumatoid arthritis: a systematic review and meta-analysis," 

International Journal of Rheumatic Diseases

. Dec. 22, 2015. DOI: 10.1111/1756-185X.12820