Background/Purpose: Rheumatoid arthritis (RA) has been associated with an increased risk of developing atrial fibrillation (AF). However, recent data on trends in incidence of AF and risk factors associated with AF in RA from population-based cohorts are lacking. This study seeks to assess the risk of AF in patients with RA compared to the general population and identify predictors of AF in patients with RA.

Methods: Retrospective medical records review was completed to form an inception cohort of all patients with RA in 1990-2019, among residents of a geographically defined area, aged ≥18 years. The incidence date of RA was defined as the earliest date at which the patient fulfilled the 1987 or 2010 classification criteria for RA. Each patient with RA was matched on age, sex, year, and county to a randomly selected comparator without RA (using the date of RA as the index date for the matched referent without RA). Patients were followed until diagnosis of new-onset AF, death, migration, or 12/31/2023. AF was defined using a previously published electronic algorithm. Descriptive statistics and Cox models adjusted for age, sex, and calendar year of RA incidence were conducted.

Results: 3798 patients were included, with 1899 patients with RA and 1899 patients without RA (mean age 55.9 years, 68% female). RA status was not found to be a significant risk factor to predict AF (adjusted for age, sex, calendar year, smoking status, and obesity) (HR 1.10; 95% CI 0.92-1.33). Among patients with RA, significant risk factors associated with incident AF included age (HR:2.29 per 10 year increase; 95%CI:2.05-2.56), male sex (HR:1.57; 95%CI:1.22-2.03), former smoking (HR:1.35; 95%CI:1.01-1.81), current smoking (HR:2.16, 95%CI:1.51-3.09), obesity (HR:1.83, 95%CI:1.42-2.37), diabetes (HR:1.54, 95%CI:1.09-2.17), and hypertension (HR:1.60, 95%CI:1.20-2.13). Additionally, for patients with RA the following disease characteristics were associated with increased risk of AF: radiographic joint erosions or destructive changes (HR 1.36; 95% CI 1.03-1.79), rheumatoid nodules (HR 1.70; 95% CI 1.19-2.43), large joint swelling (HR 1.35; 95% CI 1.04-1.76), and severe extra-articular manifestations (HR 2.03; 95% CI 1.31-3.14).

Conclusion: While RA was not a risk factor for AF, adverse cardiovascular risk profile and RA disease severity significantly increased the risk of AF among patients with RA. Future studies will inform to what extent early recognition and management of these risk factors can help improve AF outcomes in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-incident-atrial-fibrillation-in-rheumatoid-arthritis-patients-a-population-based-cohort-study/