Risk of incident atrial fibrillation in patients with rheumatoid arthritis: a systematic review and meta-analysis

Int J Rheum Dis. 2017 Apr;20(4):434-441. doi: 10.1111/1756-185X.12820. Epub 2015 Dec 22.

Abstract

Aims: Patients with rheumatoid arthritis (RA) might be at an increased risk of developing atrial fibrillation (AF) as a result of deleterious effects of inflammatory cytokines on cardiomyocytes. This study aimed to comprehensively review all available evidence to further characterize this possible association.

Methods: We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio, incidence ratio or standardized incidence ratio with 95% confidence intervals comparing the risk of incidence of AF in patients with RA versus non-RA participants. Pooled risk ratio and 95% confidence interval were calculated using random-effect, generic inverse-variance methods of DerSimonian and Laird.

Results: Three retrospective cohort studies with 39 912 cases of RA and 4 269 161 non-RA controls were included in the data analysis. The pooled risk ratio of subsequent development of AF in patients with RA versus controls was 1.29 (95% CI, 1.05-1.59). The statistical heterogeneity was moderate with an I2 of 71%.

Conclusion: Our meta-analysis demonstrated a statistically significant increased risk of subsequent development of AF among patients with RA.

Keywords: clinical aspects (rheumatoid arthritis); epidemiology (rheumatoid arthritis).

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / epidemiology*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology*
  • Chi-Square Distribution
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Odds Ratio
  • Risk Assessment
  • Risk Factors