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Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish
Majd Bairkdar1, Zihan Dong2, Pontus Andell3,4
1Clinical Epidemiology Unit, Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden majd.bairkdar@ki.se.
Insights
Patients with systemic sclerosis (SSc) have a doubled risk of developing cardiac arrhythmia, particularly early after diagnosis. This condition significantly increases mortality risk in SSc patients.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Systemic sclerosis (SSc) is a complex autoimmune disease with potential multi-organ involvement.
- Cardiac complications, including arrhythmias, are a concern in SSc patients.
- Understanding the temporal risk and associated factors of arrhythmia in SSc is crucial for patient management.
Purpose of the Study:
- To investigate the incidence and temporal risk of cardiac arrhythmia in patients with systemic sclerosis (SSc).
- To identify risk factors associated with arrhythmia development in SSc.
- To determine the impact of arrhythmia on mortality in SSc patients.
Main Methods:
- Nationwide Swedish registers were used to identify patients with incident SSc and matched general population comparators.
- Flexible parametric models and Cox regression were employed to analyze incidence, risk factors, and mortality association.
- Follow-up data spanned from SSc diagnosis until December 2019.
Main Results:
- Patients with SSc exhibited a 2.1-fold increased incidence of arrhythmia compared to controls.
- The risk of arrhythmia was highest within the first year post-SSc diagnosis (HR 3.0).
- Male sex, older age, and pulmonary arterial hypertension were identified as significant risk factors for arrhythmia in SSc; arrhythmia was linked to a 2.2-fold increased mortality risk.
Conclusions:
- Systemic sclerosis is associated with a significantly higher incidence of cardiac arrhythmia.
- Arrhythmia appears to be an early manifestation in SSc and is a predictor of increased mortality.
- Early detection and management of cardiac arrhythmia are vital in SSc care.
Objectives:
The objectives of this study are to study the risk of developing cardiac arrhythmia and its subtypes over time in patients with systemic sclerosis (SSc), to assess potential risk factors for arrhythmia in SSc and to explore whether arrhythmia is associated with mortality.
Methods:
We used nationwide Swedish registers to identify patients with incident SSc 2004-2019 and matched general population comparators (1:10). The primary outcome was incident arrhythmia. Follow-up started at the date of SSc diagnosis and ended at the primary outcome, death, emigration or 31 December 2019. We estimated the incidence of arrhythmia overall and stratified by subtype and explored the relative risk in relation to time since diagnosis using flexible parametric models. We used Cox regression to study risk factors for arrhythmia and the association of arrhythmia with mortality.
Results:
We identified 1565 patients and 16 009 comparators. The overall incidence of arrhythmia was 255 (95% CI 221 to 295) and 119 (95% CI 112 to 127) per 10 000 person years in patients with SSc and comparators, respectively, corresponding to an IRR of 2.1 (95% CI 1.8 to 2.5). The greatest hazard difference between patients with SSc compared with the comparators was seen in the first year of follow-up (HR for arrhythmia 3.0; 95% CI 2.3 to 3.8). Atrial fibrillation and flutter were the most common arrhythmia subtypes. Male sex, index age and pulmonary arterial hypertension were significant risk factors for arrhythmia in SSc. Incident arrhythmia was significantly associated with mortality (HR 2.2; 95% CI 1.6 to 3.0).
Conclusion:
SSc is associated with higher incidence of cardiac arrhythmia compared with general population. Arrhythmia seems to be an early manifestation of SSc and is associated with higher mortality.
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