It’s well known that people with rheumatoid arthritis, or RA, are at increased risk of cardiovascular disease, but new research quantifies their risk of a specific type: atrial fibrillation. A new study shows that RA patients are 60 percent more likely to develop atrial fibrillation than those without RA.
Atrial fibrillation isn’t usually life threatening, but it can cause a stroke or, if left uncontrolled, lead to heart failure. It occurs when the two upper chambers of the heart, the atria, beat out of sync with the two lower chambers, the ventricles. This affects the heart’s ability to properly pump blood out of the heart.
”The message for patients and their doctors is, if you have RA you should keep watch for any symptoms of atrial fibrillation,” says study author Abhishek Deshmukh, MD, a cardiology fellow at the University of Arkansas for Medical Sciences in Little Rock. Symptoms of atrial fibrillation, which can be managed with medications or other treatments, include a fluttering feeling in the chest, racing heart, dizziness, confusion and/or shortness of breath. “Patients have to be vigilant about this and doctors have to be vigilant about this too,” he adds.
Dr. Deshmukh presented the findings in May 2011 at the Heart Rhythm Society meeting in San Francisco. He and his research team sifted through a database of more than 400,000 patients older than 65 who were treated for atrial fibrillation at 1,200 hospitals in the U.S. They discovered the odds of developing the heart problem were 1.6 times higher for RA patients than those without the inflammatory condition. Dr. Deshmukh says the inflammation that occurs with RA is likely linked with the heart problem.
“The study is interesting as one which suggests a hypothesis of a possible link between RA and atrial fibrillation,” says Eric Matteson, MD, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minn. “Inflammation in the heart can affect the blood supply to the electrical system of the heart, which can have the result that the normal electrical impulses are not properly conducted. This can lead to rhythm disturbances like atrial fibrillation and even heart block.” Dr. Matteson says more work is needed to better understand this possible association.
According to Dr. Matteson, one of the study’s limitations is the use of administrative databases such as hospital-discharge data, which might be inaccurate. He also says patients with RA discharged from the hospital may not be representative of all RA patients.
But he and other doctors agree the study findings serve as a reminder to patients to stay on top of their health and their RA.
“We know there’s increased risk for cardiovascular disease for patients with RA,” says David Pisetsky, MD, a professor of medicine at Duke University Medical Center in Durham, N.C., “What you want to do is things that decrease risk.” He recommends quitting smoking, keeping weight in a healthy range, and treating abnormal lipid levels. “There is probably good reason to think the degree of control of inflammation matters, so disease should be under control,” he says.
Dr. Pisetsky adds that this research is an important reminder to RA patients to familiarize themselves with the symptoms of atrial fibrillation and make sure they’re regularly checking with their doctor to be screened for heart problems or abnormalities.