Introduction:
Inflammation plays a vital role on the pathophysiology of atrial fibrillation (AF). Although it is hypothesized that chronic inflammatory diseases (CIDs) may increase the risk for incident AF, data are scarce regarding whether CIDs are associated with incidence of AF.
Objectives:
To determine associations of CIDs with incident AF in a large cohort comprised of patients with multiple different CIDs.
Methods:
Patients who visited outpatient clinic regularly due to CIDs (human immunodeficiency virus infection, inflammatory bowel disease, psoriasis, rheumatoid arthritis, systemic sclerosis [SSc], and systemic lupus erythematosus [SLE]) and frequency-matched controls (in regular primary care/general medicine clinic) were extracted from the Northwestern electronic health records between 1/1/2000-1/1/2019. Multiple imputation was used for imputing missing values and all following statistical analyses. Cumulative incidence of AF was estimated by the Kaplan Meier Curve, and adjusted Cox proportional hazard models were used to compute hazard ratio (HR) for each CID.
Results:
We analyzed a total number of 37,601 patients (18,847 CIDs and 19,871 controls without CIDs, median age 48.4 years, male 43%). During a median follow-up period of 3.6 years, 1076 cases (2.9%) of incident AF were observed. After adjusting for covariates included in CHARGE-AF risk score, baseline year, insurance type, baseline hypertension, and estimated glomerular filtration rate, both SSc (HR, 2.29: 95% confidence interval [CI], 1.72 - 3.06; p < 0.01) and SLE (HR, 2.18; 95% CI, 1.65 - 2.90; p < 0.01) were associated with a significantly elevated incidence of AF (Table).
Conclusions:
Patients with SSc or SLE had a significantly elevated incidence of AF after multivariable adjustment. Future studies should investigate mechanisms underlying these findings to generate both disease-specific knowledge and more generalizable knowledge regarding inflammatory contributors to AF.