Patients with psoriatic arthritis (PsA) and the general population have similar mortality rates from acute myocardial infarction (AMI), according to study results published in Clinical and Experimental Rheumatology.
Patients with rheumatic diseases have higher cardiovascular (CV) risk. Research has shown that the risk of developing CV disease is 43% higher in patients with PsA, with a 68% increase in risk for AMI, compared with the general population.
To better understand the epidemiologic characteristics, the burden of hospitalizations, and cardiovascular disease mortality in patients with PsA, researchers used data from the National Inpatient Sample (NIS), which includes the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for diagnoses and procedures. A propensity score matching model was used to create a matched cohort between PsA and non-PsA in AMI, and a survey-weighted logistic regression model was used to describe inpatient mortality.
Between 2004 and 2014, 4778 unmatched weighted hospitalizations were estimated for AMI with underlying PsA. Mean age for hospitalizations with AMI and PsA was significantly lower compared with those without PsA (average age, 63.1±11.5 vs 67.5+14.4, respectively; P <.05), with men having an increased risk for hospitalizations (62.7% vs 60.4%, respectively; P <.05).
Overall mortality was found to be significantly lower in hospitalizations with vs without PsA (2.21% vs 5.8%, respectively; P <.05). After propensity matching analysis, in-hospital mortality in the PsA group was lower compared with the non-PsA group (1.79% vs 5.71%, respectively; odds ratio, 0.30; CI, 0.14-0.64; P =.002).
Trends in mortality among AMI with PsA did not show any distinct patterns during the study period for the matched and unmatched group, suggesting no significant change over the decade for patients with PsA.
Because this is a retrospective and observational study, the change in trends may have represented an association rather than a causation. The NIS has one of the most reliable sources of data on hospital admissions and discharges, but it is limited based on administrative coding that may be individualized for each institution. Further, there was no information on medications or laboratory results to assess disease activity or type of treatment affecting CV risk.
“PsA is associated with an increased risk of CV risk factors and CV events but does not seem to affect mortality associated with AMI,” the study authors concluded.
Jatwani S, Jatwani K, Tiwari P, Wadhwa N, Chugh K. Trends in hospitalisations and inpatient mortality from acute myocardial infarction among patients with psoriatic arthritis: an analysis of nationwide inpatient sample 2004-2014. Clin Exp Rheumatol. 2021;39(4):790-794.