Session Information
Date: Tuesday, October 23, 2018
Session Title: Health Services Research Poster III – ACR/ARHP
Session Type: ACR/ARHP Combined Abstract Session
Session Time: 9:00AM-11:00AM
Background/Purpose:
Psoriatic arthritis (PsA) is associated with an increased risk of cardiovascular morbidity and mortality. The increase in cardiovascular risk evaluated in a meta-analysis on PsA was around 43% for cardiovascular diseases, independently from traditional cardiovascular risk factors. [1] Higher disease activity has been associated with increased rates of mortality. There is limited data on comprehensive nationwide analysis of inpatient mortality in patients admitted for acute myocardial infarction (AMI) with underlying PsA. Our objectives are to describe the demographics & mortality trends for hospitalized patients with AMI with underlying PsA and understand the factors associated with mortality.
Methods:
All adult (>18 years) hospitalized patients between 2010 and 2014 from a nationwide inpatient sample (NIS) database were captured. ICD-9 CM codes were used to identify patients with AMI and PsA. NIS is the largest all-payer inpatient care database in the United States with approximately 8 million hospitalizations each year. Descriptive statistics were represented as means/medians for continuous and as frequencies and percentages for categorical variables. A survey weighted logistic regression model was used to describe inpatient mortality.
Results:
From 2010 to 2014 around 2691 patients were hospitalized for AMI with underlying PsA. Mean age of these patients was 63.788 (significantly lower than those without PsA), and 37.98% were females. Most of patients with PsA and AMI were Caucasian (89.7%) and had private insurances (42.65%). There were 52 inpatient deaths in 5 years. Higher age was associated with significantly higher odds of inpatient mortality. But the odds of mortality in patients admitted with AMI with underlying PsA were found to be lower than their counterparts. (OR = .470 ± 0.145, p value=0.01)
Conclusion:
Patients admitted with AMI and underlying PsA are younger in comparison to their counterparts. This could likely reflect cumulative effect of inflammatory burden as well as cardiovascular risk factors. Decrease in odds of cardiovascular mortality associated with PsA possibly reflects increased awareness of cardiovascular risks in patients with PsA as well increase treatment options to control inflammatory burden. Reinforcing and educating involved stakeholders will continue to improve cardiovascular outcomes in patients with PsA
References:
- Polachek A et al. Arthritis Care Res (Hoboken). 2017 Jan;69(1):67-74. doi: 10.1002/acr.22926. PubMed PMID: 27111228.
Table 1: Baseline Characteristics of patients with Acute Myocardial Infarction and Psoriatic arthritis, National Inpatient Sample 2010-2014
|
2010 |
2011 |
2012 |
2013 |
2014 |
Total |
|
|
N (patients with AMI & PsA) |
391 |
421 |
540 |
604 |
735 |
2691 |
|
Age in years (Mean ± se) |
59.742 ± 1.36 |
65.3 ± 1.12 |
65.5 ± 0.95 |
63.19 ± 1.11 |
64.27 ± 0.90 |
63.79 ± 0.49 |
|
Sex (%) |
||||||
|
Male |
60.42 |
60.33 |
64.81 |
58.68 |
62.59 |
62.02 |
|
Females |
39.58 |
39.67 |
35.19 |
41.32 |
37.41 |
37.98 |
|
Race (%) |
||||||
|
White |
75.91 |
82.69 |
93 |
90.09 |
89.21 |
89.7 |
|
African American |
11.22 |
2.61 |
0 |
1.8 |
2.16 |
2.06 |
|
Hispanic |
7.02 |
6.42 |
3 |
5.41 |
2.16 |
3.66 |
|
Asian/pacific islander |
2.29 |
3.01 |
3 |
0.9 |
0.72 |
1.49 |
|
Native American |
0.86 |
0 |
0 |
0 |
2.16 |
0.62 |
|
Other |
2.7 |
5.28 |
1 |
1.8 |
3.6 |
2.46 |
|
Insurance status (%) |
||||||
|
Medicare |
57.74 |
61.63 |
60 |
47.93 |
51.77 |
51.27 |
|
Medicaid |
6.86 |
1.05 |
47.6 |
4.96 |
3.55 |
3.22 |
|
Private insurance |
28.71 |
34.95 |
33.33 |
45.45 |
39.72 |
42.65 |
|
Self-pay |
6.69 |
2.37 |
1.9 |
1.65 |
4.96 |
2.86 |
|
Median household income for patient’s zip code (%) |
||||||
|
0-25th percentile |
29.38 |
22.06 |
24.3 |
21.67 |
19.44 |
21.42 |
|
26th to 50th percentile (median) |
27.09 |
28.05 |
22.43 |
27.5 |
32.64 |
26.96 |
|
51st to 75th percentile |
23.87 |
24.61 |
20.56 |
26.67 |
27.08 |
25.23 |
|
76th to 100th percentile |
19.67 |
25.29 |
32.71 |
24.17 |
20.83 |
26.39 |
|
Hospital location (%) |
||||||
|
Rural |
11.71 |
9.86 |
6.48 |
8.26 |
10.2 |
8.15 |
|
Urban |
88.29 |
90.14 |
93.52 |
91.74 |
89.8 |
91.85 |
|
Hospital size (%) |
||||||
|
Small |
10.02 |
7.86 |
6.48 |
13.22 |
14.29 |
11.48 |
|
Medium |
21.09 |
23.63 |
23.15 |
20.66 |
24.49 |
23.87 |
|
Large |
68.9 |
68.51 |
70.37 |
66.12 |
61.22 |
64.66 |
|
Teaching status of hospital (%) |
||||||
|
Non-teaching |
55.21 |
48.56 |
50.93 |
47.11 |
34.69 |
45.7 |
|
Teaching |
44.79 |
51.54 |
49.07 |
52.89 |
65.31 |
54.3 |
|
Geographical region (%) |
||||||
|
Northeast |
19.7 |
16.62 |
21.33 |
23.14 |
22.45 |
20.42 |
|
Midwest |
25.05 |
29.97 |
19.44 |
28.93 |
19.05 |
24.23 |
|
South |
37.58 |
28.03 |
33.33 |
23.97 |
37.42 |
30.37 |
|
West |
17.66 |
25.38 |
25.93 |
23.97 |
21.09 |
24.98 |
To cite this abstract in AMA style:
Jatwani S, Chugh K, Jatwani K, Modi V, Kaur J. A 5-Year National Trend in Acute Myocardial Infarctionamong Hospitalized Patients with Psoriatic Arthritis: Data from National Inpatient Sample [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/a-5-year-national-trend-in-acute-myocardial-infarctionamong-hospitalized-patients-with-psoriatic-arthritis-data-from-national-inpatient-sample/. Accessed April 19, 2019.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-5-year-national-trend-in-acute-myocardial-infarctionamong-hospitalized-patients-with-psoriatic-arthritis-data-from-national-inpatient-sample/