DEMOGRAPHICS AND IN-HOSPITAL OUTCOMES OF PATIENTS WITH RHEUMATOID ARTHRITIS WITH CONSTRICTIVE PERICARDITIS WHO UNDERWENT PERICARDIECTOMY

Therapeutic Area

ASCVD/CVD in Special Populations

Background

Pericarditis can occur as a manifestation of systemic rheumatic arthritis (RA). However, constrictive pericarditis is an unusual complication primarily considered to be related to chronic inflammation leading to thickening and scarring of the pericardium. The prognosis has been shown to be very poor unless the constriction is relieved surgically. Patients with RA have significant comorbidities that could impact prompt diagnosis and outcomes after pericardiectomy. Data related to the clinical implications of RA in patients undergoing pericardiectomy is scarce.

Methods

The US National Inpatient Database was queried from 2011 to 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We identified patients admitted with constrictive pericarditis who had a pericardiectomy. We compared baseline characteristics and in-hospital outcomes of patients who underwent pericardiectomy for constrictive pericarditis with vs. without rheumatoid arthritis (RA).

Results

We identified 5,493 patients with constrictive pericarditis who underwent pericardiectomy. Of these population, 221 (4%) had RA. There was a predominantly male affection in both groups. Patients with RA who underwent pericardiectomy were older (61.3 ± 9 years vs. 60.6 ± 13, p <0.001), use tobacco more frequently (51.1% vs. 34.3%, p <0.001), had more chronic obstructive pulmonary disease (33.5% vs. 18%, p <0.001), pulmonary hypertension (33.5% vs. 18.1%, p <0.001), and anxiety (15.8% vs. 8.6%, p <0.001) compared to the group without RA.

Those with RA were less likely to be male, have hyperlipidemia, or chronic kidney disease compared to patients without RA.

There was no difference in all cause-in hospital mortality between groups, and patients with RA had shorter length of stay.

Conclusions

In this large retrospective US analysis, there was no difference in all-cause mortality or in-hospital complications in patients with or without RA who underwent pericardiectomy for constrictive pericarditis. It must be considered that the nature of this analysis does not account for time since diagnosis or severity of RA, and it has been reported that constriction appears during later timeframes and is more frequent with greater severity of disease in patients with RA.