Large Vessel Vasculitis Increases Risk of Cardiovascular Events, Renal Injury in Atrial Fibrillation

An analysis of data from the National Inpatient Sample (NIS) presented at the Congress of Clinical Rheumatology (CCR) East 2023 annual meeting offers an overview of an apparent increase in risk of negative outcomes in patients with large vessel vasculitis during hospitalizations for atrial fibrillation.

Results of the study indicate large vessel vasculitis was associated with increased risk of major adverse cardiovascular events, adverse renal outcomes, and a longer length of stay, but no increase in risk for mortality or stroke, among a cohort of more than 1 million patients hospitalized with atrial fibrillation from 2016-2019.¹

“Patients with atrial fibrillation had a significant risk of acute myocardial infarction, significantly higher risk of MACE and acute kidney injury, with the length of stay a little bit longer as well for patients who were admitted. However, no significant difference in in hospital mortality, stroke, and bleeding,” said Sabahat Usmani, MD, a resident physician at Louis A. Weiss Memorial Hospital, during her presentation at CCR East 2023.

The most common form of treated arrhythmia in the US, atrial fibrillation is responsible for more than 26,000 deaths in the US in 2019, according to statistics from the US Centers for Disease Control and Prevention. By 2030, an estimated 12.1 million people in the US will be diagnosed with atrial fibrillation.²

The current study was conducted by Usmani and fellow investigators with the intent of determining the impact of large vessel vasculitis on cardiovascular outcomes in patients hospitalized with atrial fibrillation. The primary outcomes of interest for the study were in-hospital outcomes and resource utilization. Specific hospital outcomes of interest included major adverse cardiac and cerebrovascular events (MACCE), acute myocardial infarction (AMI), and acute kidney injury.¹

With their period of interest defined as 2016-2019, the investigators’ search of the NIS yielded 1,041,670 atrial fibrillation hospitalizations, including 1090 among patients with large vessel vasculitis, for inclusion in the current study. Of the 1090 with large vessel vasculitis, 1050 had giant cell arteritis and 40 had Takayasu arteritis. Investigators pointed out atrial fibrillation patients with large vessel vasculitis were older and more likely to be female than their counterparts without large vessel vasculitis.¹

In adjusted analysis, results indicated patients with large vessel vasculitis had a significantly higher risk of MACCE (adjusted odds ratio [aOR], 1.72 [95% confidence interval [CI], 1.02-2.89]), AMI (aOR, 1.99 [95% CI, 1.13-3.51]), and acute kidney injury (aOR, 9.73 [95% CI, 2.33-40.68]). Analysis of resource utilization endpoints indicated those with large vessel vasculitis also had a longer length of stay than those without (3.38±3.73 vs 4.44±4.23).¹

Investigators called attention to an apparent reduction in risk of heart failure in atrial fibrillation patients with large vessel vasculitis relative to their counterparts without (aOR, 0.60 [95% CI, 0.42-0.78]), but there were no differences observed between groups for in-hospital mortality, stroke, major bleeding, need for coronary intervention, or total charge of hospitalization.¹

“We think that, for patients who have atrial fibrillation and have a history of vasculitis, they should be more aggressively treated and monitored more closely,” Usmani concluded. “Having said that: do patients with vasculitis do they need to be screened for AFib? We don't know and we cannot say not based on this, but this is something that we should be looking at.”

References:

1. Usmani S, Raksadawan Y, Taha A, et al. Impact and Cardiovascular Outcomes of Large Vessel Vasculitis in Atrial Fibrillation Hospitalization: A Nationwide Inpatient Database Study. Paper presented at: Paper presented at: Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting. Destin, FL. May 4 – 7, 2023.
2. Atrial fibrillation. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm. Published October 14, 2022. Accessed May 5, 2023.