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. 2012 Mar 8:344:e1257.
doi: 10.1136/bmj.e1257.

Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study

Jesper Lindhardsen  1 , Ole Ahlehoff, Gunnar Hilmar Gislason, Ole Rintek Madsen, Jonas Bjerring Olesen, Jesper Hastrup Svendsen, Christian Torp-Pedersen, Peter Riis Hansen
Affiliations

Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study

Jesper Lindhardsen et al. BMJ. .

Abstract

Objectives: To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.

Design: Longitudinal nationwide register based cohort study.

Setting: Inpatient and outpatient hospital care in Denmark from 1997 to 2009.

Participants: Entire Danish population aged over 15 years without rheumatoid arthritis, atrial fibrillation, or stroke before 1997. Participants with rheumatoid arthritis were identified by individual level linkage of diagnoses and rheumatoid arthritis treatment.

Main outcome measures: Rates of atrial fibrillation and stroke.

Results: Of 4,182,335 participants included in the cohort, 18,247 were identified as having rheumatoid arthritis during follow-up, with a mean age at disease onset of 59.2 years and a median follow-up of 4.8 years. A total of 156,484 people, including 774 with rheumatoid arthritis, were diagnosed as having atrial fibrillation (age and sex matched event rates of 8.2 per 1000 person years in rheumatoid arthritis patients and 6.0 per 1000 person years in the general population), with an adjusted incidence rate ratio of 1.41 (95% confidence interval 1.31 to 1.51). In addition, 165,343 people, including 718 with rheumatoid arthritis, had a stroke (7.6 per 1000 person years in rheumatoid arthritis and 5.7 per 1000 person years in the general population), with a resultant rate ratio of 1.32 (1.22 to 1.42). For both atrial fibrillation and stroke, relative risks were increased in all strata based on thirds of sex and age, with higher relative risks in younger patients but higher absolute risk differences in older patients.

Conclusions: Rheumatoid arthritis was associated with an increased incidence of atrial fibrillation and stroke. The novel finding of increased risk of atrial fibrillation in rheumatoid arthritis suggests that this arrhythmia is relevant in cardiovascular risk assessment of these patients.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of study population
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Fig 2 Rates of atrial fibrillation in general population and patients with rheumatoid arthritis
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Fig 3 Rates of stroke in general population and patients with rheumatoid arthritis
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