Background/Purpose: Venous thromboembolism (VTE) is a major health problem and can be potentially fatal when complicated by lethal pulmonary embolism (PE). Previous hospital-based studies have reported an increased risk of VTE among hospitalized patients with rheumatoid arthritis (RA), particularly in the first year after admission for RA (1). The relative risk of VTE in patients with RA hospitalized for other causes besides joint surgery was 1.99. (2) Data describing differences in mortality and morbidity of patients with a history of rheumatoid arthritis is limited in current literature.  In our study, we discuss the potential impact on mortality, length of stay, and cost of hospitalization in patients admitted with VTE with a history of RA.

Methods: We analyzed hospitalizations for VTE (both Deep Venous Thrombosis and PE) among adults in the Nationwide Inpatient Sample (NIS). Patients were stratified into two groups based on the status of RA; using ICD-9 CM diagnostic codes. Descriptive statistics were represented as means/medians for continuous and as frequencies and percentages for categorical variables. A survey weighted multivariate regression analysis was used to adjust for confounders when comparing mortality, length of stay, and total charges.

Results: A total of 1,481,777 admissions with a primary diagnosis of VTE were identified from 2012-2014, and amongst these patients, 33,152 patients had an underlying diagnosis of RA. Patients with underlying RA were older (average age 68.42years vs. 63.19 years), more often females (73.86% vs. 52.16%), and had multiple comorbidities, as described in Table 1. Patients with RA had a significantly longer length of stay (LOS) compared to those without RA (Avg LOS 5.1 days vs. 4.9 days, p value=0.00), but mortality rates were lower in this population (1.67% vs. 2.01%,p value=0.05).

Conclusion: VTE is a major healthcare burden in the US population, and RA has been associated with an increased risk of VTE. Endothelial dysfunction in inflammatory diseases accelerates microvascular thrombosis cascade. Even though RA may not affect the mortality in patients with VTE, this study shows increased morbidity with increased length of stay and cost per hospitalization. Hospitalized RA patients should be evaluated for known risk factors for VTE and should be initiated on VTE prophylaxis at admission unless contraindicated. We also recommend additional analytic studies in other databases to confirm these findings, further quantify the risks, and also develop appropriate monitoring and prophylactic strategy in the hospitalized RA population.

ACR RA VTE Table1

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-associated-with-longer-hospital-stays-in-patients-admitted-with-venous-thromboembolism-a-nationwide-analysis-2010-2014/