Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based study
Objectives The objectives of this study are to study the risk of developing cardiac arrhythmia and its subtypes over time in patients with systemic sclerosis (SSc), to assess potential risk factors for arrhythmia in SSc and to explore whether arrhythmia is associated with mortality.Methods We used n...
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BMJ Publishing Group
2024-09-01
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| Series: | RMD Open |
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| author | Pontus Andell Marie Holmqvist Roger Hesselstrand Majd Bairkdar Zihan Dong |
| author_facet | Pontus Andell Marie Holmqvist Roger Hesselstrand Majd Bairkdar Zihan Dong |
| author_sort | Pontus Andell |
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| description | Objectives The objectives of this study are to study the risk of developing cardiac arrhythmia and its subtypes over time in patients with systemic sclerosis (SSc), to assess potential risk factors for arrhythmia in SSc and to explore whether arrhythmia is associated with mortality.Methods We used nationwide Swedish registers to identify patients with incident SSc 2004–2019 and matched general population comparators (1:10). The primary outcome was incident arrhythmia. Follow-up started at the date of SSc diagnosis and ended at the primary outcome, death, emigration or 31 December 2019. We estimated the incidence of arrhythmia overall and stratified by subtype and explored the relative risk in relation to time since diagnosis using flexible parametric models. We used Cox regression to study risk factors for arrhythmia and the association of arrhythmia with mortality.Results We identified 1565 patients and 16 009 comparators. The overall incidence of arrhythmia was 255 (95% CI 221 to 295) and 119 (95% CI 112 to 127) per 10 000 person years in patients with SSc and comparators, respectively, corresponding to an IRR of 2.1 (95% CI 1.8 to 2.5). The greatest hazard difference between patients with SSc compared with the comparators was seen in the first year of follow-up (HR for arrhythmia 3.0; 95% CI 2.3 to 3.8). Atrial fibrillation and flutter were the most common arrhythmia subtypes. Male sex, index age and pulmonary arterial hypertension were significant risk factors for arrhythmia in SSc. Incident arrhythmia was significantly associated with mortality (HR 2.2; 95% CI 1.6 to 3.0).Conclusion SSc is associated with higher incidence of cardiac arrhythmia compared with general population. Arrhythmia seems to be an early manifestation of SSc and is associated with higher mortality. |
| format | Article |
| id | doaj-art-6e15d0c8241c4db4b7ff55980ede0277 |
| institution | DOAJ |
| issn | 2056-5933 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-6e15d0c8241c4db4b7ff55980ede02772025-08-20T03:03:44ZengBMJ Publishing GroupRMD Open2056-59332024-09-0110310.1136/rmdopen-2024-004532Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based studyPontus Andell0Marie Holmqvist1Roger Hesselstrand2Majd Bairkdar3Zihan Dong4Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden2 Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, SwedenDepartment of Rheumatology, Lund University, Lund, SwedenClinical Epidemiology Unit, Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden1 Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, SwedenObjectives The objectives of this study are to study the risk of developing cardiac arrhythmia and its subtypes over time in patients with systemic sclerosis (SSc), to assess potential risk factors for arrhythmia in SSc and to explore whether arrhythmia is associated with mortality.Methods We used nationwide Swedish registers to identify patients with incident SSc 2004–2019 and matched general population comparators (1:10). The primary outcome was incident arrhythmia. Follow-up started at the date of SSc diagnosis and ended at the primary outcome, death, emigration or 31 December 2019. We estimated the incidence of arrhythmia overall and stratified by subtype and explored the relative risk in relation to time since diagnosis using flexible parametric models. We used Cox regression to study risk factors for arrhythmia and the association of arrhythmia with mortality.Results We identified 1565 patients and 16 009 comparators. The overall incidence of arrhythmia was 255 (95% CI 221 to 295) and 119 (95% CI 112 to 127) per 10 000 person years in patients with SSc and comparators, respectively, corresponding to an IRR of 2.1 (95% CI 1.8 to 2.5). The greatest hazard difference between patients with SSc compared with the comparators was seen in the first year of follow-up (HR for arrhythmia 3.0; 95% CI 2.3 to 3.8). Atrial fibrillation and flutter were the most common arrhythmia subtypes. Male sex, index age and pulmonary arterial hypertension were significant risk factors for arrhythmia in SSc. Incident arrhythmia was significantly associated with mortality (HR 2.2; 95% CI 1.6 to 3.0).Conclusion SSc is associated with higher incidence of cardiac arrhythmia compared with general population. Arrhythmia seems to be an early manifestation of SSc and is associated with higher mortality.https://rmdopen.bmj.com/content/10/3/e004532.full |
| spellingShingle | Pontus Andell Marie Holmqvist Roger Hesselstrand Majd Bairkdar Zihan Dong Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based study RMD Open |
| title | Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based study |
| title_full | Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based study |
| title_fullStr | Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based study |
| title_full_unstemmed | Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based study |
| title_short | Arrhythmia in patients with systemic sclerosis: incidence, risk factors and impact on mortality in a Swedish register-based study |
| title_sort | arrhythmia in patients with systemic sclerosis incidence risk factors and impact on mortality in a swedish register based study |
| url | https://rmdopen.bmj.com/content/10/3/e004532.full |
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