Session Information
Date: Tuesday, October 23, 2018
Title: Epidemiology and Public Health Poster III: SLE, SSc, APS, PsA, and Other Rheumatic Diseases
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Hydroxychloroquine (HCQ) is a derivative of quinidine, a class 1a anti-arrhythmic agent used to prevent ventricular arrhythmias and recurrent atrial fibrillation (AFib). AFib occurs more commonly in patients with rheumatoid arthritis (RA) compared to the general population. HCQ is commonly used to treat mild RA. This study examines the association of HCQ use and AFib or ventricular arrhythmias in RA.
Methods: A retrospective cohort of adult RA (ICD10: M05 and M06) patients at a tertiary academic rheumatology practice from Dec 1,2014 to May 30,2017 excluding patients with prevalent AFib was constructed. Patients were categorized as HCQ users versus nonusers. Primary outcome was incident AFib adjudicated by electronic health record (EHR) review and EKG confirmation. AFib events occurring in the first year of observation were considered prevalent AFib to allow for a run-in period and exclude prevalent cases more reliably. Secondary outcome was incident ventricular arrhythmias- a composite of ventricular tachycardia (VT), ventricular fibrillation (VF), torsades and sudden cardiac death (SCD) adjudicated similarly. Multivariate regression analysis was performed to estimate the association between HCQ exposure and development of incident AFib, after adjusting for relevant confounders, including demographics (age, sex, ethnicity), AFib‐related co-morbidities (BMI, smoking, alcohol use, chronic obstructive pulmonary disease, obstructive sleep apnea, hypertension, coronary artery disease, heart failure, diabetes, cerebrovascular accident and transient ischemic attack, peripheral vascular disease, thyroid disorder, chronic kidney disease and liver dysfunction), anti-arrhythmic medication use (beta-blockers, calcium channel blockers, flecainide, digoxin, amiodarone), and autoimmune serologies. Sub-group analysis was performed on patients age >65yrs (given higher risk of AFib).
Results: Our study included 5697 patients with RA, including 1304 HCQ users. During the observation period, 28 incident AFib events occurred in HCQ users and 54 in non-users. Unadjusted odds ratio (OR) was calculated at 1.76 (95% CI 1.11-2.80, p=0.02), and multivariable logistic regression analysis showed an OR of 2.07 (95% CI 1.30-3.30, p=0.002) for incident AFib. Three incident ventricular arrhythmias occurred in HCQ users and 7 in non-users, all were VT, with OR of 1.44 (95% CI 0.37-5.59, p=0.59). In the age>65 yrs sub-group analysis, OR was 1.99 (95% CI 1.18-3.38, p=0.01).
|
Variable |
HCQ users (N=1304) |
HCQ non-users (n=4393) |
|
Age (yrs) |
62.4±13.3 |
65.4±13.7 |
|
Female sex |
1058 (81%) |
3277 (75%) |
|
Caucasian |
1164 (89.3%) |
3829 (87.2%) |
|
BMI (kg/m2) |
29.8±7.3 |
29.7±7.1 |
|
Smoking (ever) |
713 (55%) |
2220 (51%) |
|
Alcohol user |
504 (39%) |
1610 (38%) |
|
Anti-arrhythmic medication use |
162 (12.4%) |
87 (1.9%) |
|
HTN |
380 (29%) |
1490 (34%) |
|
COPD |
2 (0.1%) |
2 (0.1%) |
|
OSA |
80 (6%) |
94 (0.01%) |
|
CAD |
52 (4%) |
98 (2.2%) |
|
Heart failure |
32 (2.4%) |
112 (2.5%) |
|
Diabetes |
118 (9%) |
606 (13.8%) |
|
CVA/TIA |
9 (0.6%) |
84 (1.9%) |
|
Thyroid disorder |
7 (0.5%) |
15 (0.3%) |
|
Liver dysfunction |
40 (3%) |
118 (2.7%) |
|
CKD |
44 (3.3%) |
210 (4.8%) |
|
PVD |
13 (0.9%) |
66 (1.5%) |
|
Incident AFib |
28 (2.2%) |
54 (1.2%) |
|
Unadjusted Odds Ratio |
1.76 ( 95 % CI 1.11-2.80, p=0.02) |
|
|
Adjusted Odds Ratio |
2.07 (95% CI 1.30-3.30, p=0.002) |
|
Conclusion: In this exploratory study, HCQ use was associated with a 2 times higher risk of AFib in RA patients. These preliminary results need to be confirmed in larger studies given HCQ’s otherwise favorable effect on cardiovascular disease risk profile in multiple previous studies.
To cite this abstract in AMA style:
Gupta A, Joshi A, Saleem O, Chester-Wasko M, Sharma TS. Association of Hydroxychloroquine Use and Incident Atrial Fibrillation in Rheumatoid Arthritis: A Retrospective Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/association-of-hydroxychloroquine-use-and-incident-atrial-fibrillation-in-rheumatoid-arthritis-a-retrospective-study/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-hydroxychloroquine-use-and-incident-atrial-fibrillation-in-rheumatoid-arthritis-a-retrospective-study/