Alqudah Qusai, Alomari Ahmad, Daise Moh'd, Awad Ali, Rhabneh Laith, Obeidat Osama, Obeidat Omar, Alomari Samar, Alomari Safwan
University of Central Florida College of Medicine, Graduate Medical Education, Orlando, USA.
HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, USA.
Med Arch. 2025;79(2):127-134. doi: 10.5455/medarh.2025.79.127-134.
Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD) and atrial fibrillation (AF), yet data on the clinical outcomes and management of AF in RA patients remain limited.
This study aimed to evaluate the impact of RA on AF-related outcomes and treatment strategies.
We conducted a retrospective cohort study using the TriNetX US collaborative network database, including adult patients diagnosed with AF between 2015 and 2025. Patients were divided into two cohorts based on the presence or absence of RA. Propensity score matching was performed to balance baseline characteristics.
A total of 33,922 RA-AF patients and 33,922 non-RA AF patients were analyzed after matching. RA-AF patients exhibited a significantly higher risk of all-cause mortality (24.5% vs. 21.0%, OR: 1.216, p<0.001) and hospitalization or emergency department visits (72.2% vs. 69.2%, OR: 1.153, p<0.001). Additionally, RA-AF patients had a higher incidence of ischemic stroke or transient ischemic attack (13.2% vs. 11.4%, OR: 1.180, p<0.001) and composite hemorrhagic events (14.4% vs. 10.6%, OR: 1.411, p<0.001). Notably, AF with rapid ventricular response (RVR) was more common in RA-AF patients (36.1% vs. 33.5%, OR: 1.122, p<0.001). Despite the elevated thromboembolic risk, RA-AF patients demonstrated lower utilization of anticoagulation (46.9% vs. 49.4%, OR: 0.905, p<0.001) and a preference for rate control over rhythm control strategies.
RA-AF patients experience higher mortality, increased stroke and hemorrhagic risk, and more frequent hospitalizations compared to non-RA AF patients. Despite these risks, anticoagulation underutilization remains a concern.
类风湿性关节炎（RA）与心血管疾病（CVD）和心房颤动（AF）风险增加相关，但关于RA患者AF的临床结局和管理的数据仍然有限。
本研究旨在评估RA对AF相关结局和治疗策略的影响。
我们使用TriNetX美国协作网络数据库进行了一项回顾性队列研究，纳入2015年至2025年间诊断为AF的成年患者。根据是否存在RA将患者分为两个队列。进行倾向评分匹配以平衡基线特征。
匹配后共分析了33922例RA-AF患者和33922例非RA AF患者。RA-AF患者全因死亡率显著更高（24.5%对21.0%，OR：1.216，p<0.001），住院或急诊就诊率也更高（72.2%对69.2%，OR：1.153，p<0.001）。此外，RA-AF患者缺血性中风或短暂性脑缺血发作的发生率更高（13.2%对11.4%，OR：1.180，p<0.001），复合出血事件发生率更高（14.4%对10.6%，OR：1.411，p<0.001）。值得注意的是，快速心室率反应（RVR）的AF在RA-AF患者中更常见（36.1%对33.5%，OR：1.122，p<0.001）。尽管血栓栓塞风险升高，但RA-AF患者抗凝药物使用率较低（46.9%对49.4%，OR：0.905，p<0.001），且更倾向于采用心率控制而非节律控制策略。
与非RA AF患者相比，RA-AF患者死亡率更高，中风和出血风险增加，住院更频繁。尽管存在这些风险，但抗凝药物使用不足仍是一个问题。
