Patients with rheumatoid arthritis at higher risk for ‘avoidable’ hospitalization
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WASHINGTON — Patients with rheumatoid arthritis demonstrate an elevated risk for avoidable hospitalizations, particularly for cardiovascular complications, compared with healthy controls, according to data presented at ACR Convergence 2024.
“Despite the very time sensitive requirement for early diagnosis of RA, there are system-level gaps that remain,” Dani Contreras, MD, of the University of Calgary, Alberta, told attendees. “These gaps can result in uncontrolled disease activity and can lead to complications that require acute care use that would otherwise be avoidable.”
Contreras described RA as an ambulatory care-sensitive condition, in which appropriate access to ambulatory care can minimize hospitalizations. She added that individuals with RA may be susceptible to those hospitalizations.
In the current retrospective cohort study, based in Alberta, Canada, Contreras and colleagues aimed to estimate rates of avoidable hospitalizations in 52,596 individuals with RA vs. 210,384 age- and sex-matched controls.
The final analysis included hospitalizations among 25,281 patients with RA and 70,313 controls over the study duration. The overall number of hospitalizations was 83,811 for case patients and 190,304 for controls.
According to the researchers, avoidable hospitalizations for ambulatory care-sensitive conditions were reported in 8.3% for cases and 9.1% for controls.
Among individuals with RA, the most common reason for an ambulatory care sensitive hospitalization was for chronic lower respiratory diseases, at 3.8%.
Additionally, patients with RA were at a 1.12-fold greater risk for hospitalization for heart failure and pulmonary edema, compared with controls (IRR 1.12; 95% CI, 1.01-1.25).
“Hospitalizations for heart failure and pulmonary edema were consistently higher among patients with RA 3 to 5 years from the time they were diagnosed,” Contreras said. “This should not come as a surprise, as there is a higher prevalence and incidence of cardiovascular diseases among those with RA.”
Increasing age predicted ambulatory care-sensitive condition hospitalization among RA cases, as did not having seen a physician at any point since diagnosis, being from a rural location, and having comorbid conditions, particularly if the comorbid condition is also an ambulatory care-sensitive condition (HR = 7.34; 95% CI, 6.25-8.62).
“People with RA are at a higher risk for potentially avoidable hospitalizations 3 and 5 years after diagnosis vs. those without RA,” Contreras said. “This really highlights the importance of ambulatory care access.”
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Contreras D. Abstract #1714. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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