Patients with IMIDs, myocardial infarction at higher risk for death, heart failure
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Patients with rheumatic immune-mediated inflammatory disease who experience myocardial infarction are more likely to die or experience heart failure vs. patients without immune-mediated inflammatory disease, according to data.
Additionally, these patients may require coronary reintervention or experience recurrent myocardial infarction, the researchers wrote in the Journal of the American Heart Association.
“Patients with IMIDs have been shown in prior studies to have higher risk of myocardial infarction and also risk factors for heart attacks, such as hypertension, diabetes and kidney disease,” Amgad Mentias, MD, MS, FACC, FESC, of the Cleveland Clinic, told Healio. “However, their long-term risk of adverse events after heart attack is less studied.”
To investigate whether patients with IMIDs require differences in care management following myocardial infarction, as well as whether they demonstrate higher risks for adverse events, Mentias and colleagues analyzed patient files from the Medicare Provider Analysis and Review 100% Files. Data from patients admitted to hospitals with a primary diagnosis of myocardial infarction collected between January 2014 and December 2019 were analyzed.
Patients were excluded from the analysis if they were aged younger than 65 years or were not enrolled in fee-for-service care for at least 1 year prior to the incident event. In addition, the researchers used a 1-year “lookback period” to investigate potential comorbidities.
The primary outcome was all-cause mortality at the most recent available follow-up date. Secondary outcomes included in-hospital acute kidney injury, major bleeding, 30‐day and 1‐year mortality, time to myocardial infarction readmission, heart failure, stroke, need for coronary revascularization, and readmission burden for heart failure in the first year after the myocardial infarction. Mortality data were available through August 2020.
The analysis included 1,654,862 patients admitted with a myocardial infarction between 2014 and 2019. Among these patients, 3.6% had a history of IMIDs prior to the event. According to the researchers, patients with IMIDs demonstrated a higher risk for mortality (adjusted HR = 1.15; 95% CI, 1.14-1.17), heart failure (HR = 1.12; 95% CI, 1.09-1.14), recurrent myocardial infarction (HR = 1.08; 95% CI, 1.06-1.11) and coronary reintervention (HR = 1.06; 95% CI, 1.01-1.13), compared with patients without IMIDs.
“We found two important findings. One, patients with IMIDs were less likely to undergo heart catheterization, stenting or bypass surgery to treat the heart attack, which is probably due to higher risk of procedural complications in these patients, but also could be due to known sex disparities in intervention in myocardial infarction, as IMIDS are more common in women,” Mentias said. “And two, in follow-up, these patients had 15% higher risk of death, 12% higher risk of heart failure and 8% higher risk of a second heart attack.
“Rheumatologists and cardiologists should collaborate together and counsel the IMIDs patients about importance of secondary prevention after myocardial infarction,” he added. “These patients also should be offered, when feasible, coronary intervention if they are candidates and the IMIDs by itself should not preclude these patients from interventions aiming to restore the blood flow in the blocked arteries.”
Perspective
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It has long been known that patients with immune-mediated inflammatory diseases (IMIDs), such as rheumatoid arthritis and lupus, have increased mortality compared with age-matched controls. In this article, Wassif and colleagues address the issue of the management and treatment outcomes of patients with IMIDs admitted to the hospital for myocardial infarction.
In essence, this article adds to the body of literature on the adverse impact that inflammation may have on patients with IMIDs. It also demonstrates that these patients had less use of appropriate interventions and worse outcomes. The message to rheumatologists, and indeed to all health care providers who manage patients with concomitant IMIDs, is that aggressive control and treatment of underlying cardiovascular risk factors, especially in Medicare patients over the age of 65 years, is of utmost importance.
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