Rheumatoid Arthritis and Atrial Fibrillation: a Complex Cardiovascular Intersection - Insights from a Retrospective Cohort Study.

Abstract

Background: 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.

Objective: This study aimed to evaluate the impact of RA on AF-related outcomes and treatment strategies.

Methods: 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.

Results: 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.

Conclusion: 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.