OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS: A POPULATION BASED RETROSPECTIVE STUDY

ObjectivesScreening for cardiovascular risk factors and treating hyperlipidaemia with statins are recommended to reduce the increased cardiovascular risk in individuals with rheumatoid arthritis (RA). However, poor compliance with statins may limit their therapeutic benefit. Our objective was to evaluate the impact of statin discontinuation on risk of acute myocardial infarction (AMI) among RA patients.MethodsThe authors conducted a population-based cohort study of RA patients with incident statin use followed from May 1996 to March 2006 using administrative health data. Primary exposure was statin discontinuation for ≥3 months at any time during therapy course. The authors used Cox's proportional hazards models and modelled statin discontinuation as a time-dependent variable, while adjusting for age, sex, comorbidities, use of other medications influencing cardiac risk, and proxy indicators of RA severity.ResultsDuring 15 669 person-years of follow-up in 4102 incident-statin users with RA, the authors identified 264 AMI events. Statin discontinuation was associated with 67% increased risk of AMI (adjusted HR 1.67; 95% CI 1.24 to 2.25). There was a 2% increase in risk of AMI with each 1-month increase in the duration of discontinuation (adjusted HR 1.02; 95% CI 1.01 to 1.03). These associations were not modified by timing of first statin prescription, prior AMI status, sex and age (p values for interactions >0.17).ConclusionsThese population-based data indicate that RA patients who discontinue statins have increased risk of AMI. Findings emphasise the need to raise awareness, among health professionals and people with RA, of the importance of compliance with statin therapy in RA.

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Faculty Opinions recommendation of Effect on Risk of Stroke and Acute Myocardial Infarction of Nonselective Nonsteroidal Anti-Inflammatory Drugs in Patients With Rheumatoid Arthritis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733235097.793546874 ◽

2018 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Rheumatoid Arthritis ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Association of Tooth Scaling with Acute Myocardial Infarction and Analysis of the Corresponding Medical Expenditure: A Nationwide Population-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147613 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7613

Author(s):

Yi-Wei Kao ◽

Ben-Chang Shia ◽

Huei-Chen Chiang ◽

Mingchih Chen ◽

Szu-Yuan Wu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Periodontal Diseases ◽

Population Based ◽

Medical Expenditure ◽

Control Group ◽

Proportional Hazard ◽

Population Based Study ◽

Scaling Group

Accumulating evidence has shown a significant correlation between periodontal diseases and systemic diseases. In this study, we investigated the association between the frequency of tooth scaling and acute myocardial infarction (AMI). Here, a group of 7164 participants who underwent tooth scaling was compared with another group of 7164 participants without tooth scaling through propensity score matching to assess AMI risk by Cox’s proportional hazard regression. The results show that the hazard ratio of AMI from the tooth scaling group was 0.543 (0.441, 0.670) and the average expenses of AMI in the follow up period was USD 265.76, while the average expenses of AMI in follow up period for control group was USD 292.47. The tooth scaling group was further divided into two subgroups, namely A and B, to check the influence of tooth scaling frequency on AMI risk. We observed that (1) the incidence rate of AMI in the group without any tooth scaling was 3.5%, which is significantly higher than the incidence of 1.9% in the group with tooth scaling; (2) the tooth scaling group had lower total medical expenditures than those of the other group because of the high medical expenditure associated with AMI; and (3) participants who underwent tooth scaling had a lower AMI risk than those who never underwent tooth scaling had. Therefore, the results of this study demonstrate the importance of preventive medicine.

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Impact of COVID-19 pandemic lockdown on myocardial infarction care

European Journal of Epidemiology ◽

10.1007/s10654-021-00764-2 ◽

2021 ◽

Author(s):

Timo Schmitz ◽

Christa Meisinger ◽

Inge Kirchberger ◽

Christian Thilo ◽

Ute Amann ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hot Spot ◽

Population Based ◽

Downward Trend ◽

German Model ◽

Model Region ◽

The Impact ◽

The City

AbstractThe aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on acute myocardial infarction (AMI) care, and to identify underlying stressors in the German model region for complete AMI registration. The analysis was based on data from the population-based KORA Myocardial Infarction Registry located in the region of Augsburg, Germany. All cases of AMI (n = 210) admitted to one of four hospitals in the city of Augsburg or the county of Augsburg from February 10th, 2020, to May 19, 2020, were included. Patients were divided into three groups, namely pre-lockdown, strict lockdown, and attenuated lockdown period. An additional survey was conducted asking the patients for stress and fears in the 4 weeks prior to their AMI. The AMI rate declined by 44% in the strict lockdown period; in the attenuated lockdown period the rate was 17% lower compared to the pre-lockdown period. The downward trend in AMI rates during lockdown was seen in STEMI and NSTEMI patients, and independent of sex and age. The door-to-device time decreased by 70–80% in the lockdown-periods. In the time prior to the infarction, patients felt stressed mainly due to fear of infection with Sars-CoV-2 and less because of the restrictions and consequences of the lockdown. A strict lockdown due to the Covid-19 pandemic had a marked impact on AMI care even in a non-hot-spot region with relatively few cases of COVID-19. Fear of infection with the virus is presumably the main reason for the drop in hospitalizations due to AMI.

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Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619896069 ◽

2020 ◽

Vol 9 (8) ◽

pp. 931-938 ◽

Cited By ~ 1

Author(s):

Mattias Skielta ◽

Lars Söderström ◽

Solbritt Rantapää-Dahlqvist ◽

Solveig W Jonsson ◽

Thomas Mooe

Keyword(s):

Rheumatoid Arthritis ◽

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Congestive Heart Failure ◽

Cox Regression Analysis ◽

Co Morbidity ◽

One Year ◽

Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

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