Risk factors for incident atrial fibrillation in rheumatoid arthritis patients: A population based cohort study

Assess atrial fibrillation (AF) risk in patients with rheumatoid arthritis (RA) versus general population and identify predictors of AF in RA.

Retrospective medical records review was completed to form an inception cohort of all patients with RA (1990-2019), among residents of 8 southern MN counties, aged ≥18 years. Each patient with RA was matched on age, sex, year, and county to randomly selected non-RA comparator and followed until incident AF, death, migration, or 12/31/2023. AF was defined using an electronic algorithm.

1899 patients with RA and 1899 non-RA comparators (mean age 55.9 years, 68.5% female) were included. Occurrence of AF was similar in RA vs. non-RA, adjusting for age, sex, year, smoking, and obesity: HR:1.10; 95%CI:0.92-1.33. The 10-year cumulative incidence of AF was 9.5% in RA versus 8.8% in non-RA. In RA, significant risk factors for incident AF included age (HR:2.29 per 10-year increase; 95%CI:2.05-2.56), male sex (HR:1.57; 95%CI:1.22-2.03), former smoking (HR:1.35; 95%CI:1.01-1.81), current smoking (HR:2.16; 95%CI:1.51-3.09), obesity (HR:1.83, 95%CI:1.42-2.37), diabetes (HR:1.54, 95%CI:1.09-2.17), hypertension (HR:1.60; 95%CI:1.20-2.13), rheumatoid nodules (HR:1.77; 95%CI:1.23-2.55), large joint swelling (HR:1.32; 95%CI:1.01-1.73), and severe extra-articular manifestations (HR:1.88; 95%CI:1.17-3.02). AF occurrence rate was higher among patients with severe RA (i.e., erosions/destructive changes, nodules, or severe extra-articular manifestations in the first year) compared to non-RA (HR:1.46; 95%CI:1.09-1.94).

Adverse cardiovascular risk profile and RA disease severity significantly increased the risk of AF among patients with RA. Future studies will inform to what extent early recognition and management of these factors improves AF outcomes in RA.