Trends in hospitalisations and inpatient mortality from acute myocardial infarction among patients with psoriatic arthritis: An analysis of nationwide inpatient sample 2004-2014

Abstract

Objective Psoriatic arthritis (PsA) is associated with increased cardiovascular morbidity and mortality. Higher disease activity has been associated with increased rates of mortality in PsA. The objectives of the study were to describe the trends for hospitalisations from acute myocardial infarction (AMI) amongst patients with underlying PsA. Methods All adult hospitalisations for AMI with and without PsA from 2004-2014 in the nationwide in-patient sample (NIS) database were captured. A propensity score-matching model was also developed for comparative outcome analysis and reduce the potential of selection bias. Results From 2004 to 2014, 4778 unmatched weighted hospitalisations were estimated for AMI with underlying PsA. Mean age for hospitalisations with AMI and PsA was lower (average age in years: 63.1±11.5 vs. 67.5±14.4; p-value <0.05), with a higher percentage being males (62.7% vs. 60.4%, p-value <0.05). When adjusted for confounding factors, overall mortality was found to be significantly lower in hospitalisations with PsA (2.21% vs. 5.8%, p-value <0.05). After propensity matching analyses, in-hospital mortality in PsA cohort continued to be significantly lower when compared to the matched cohort without PsA (1.79% vs. 5.71%, Odds ratio=0.3, p-value 0.002). Conclusion The study suggests that overall rates of mortality in AMI with underlying PsA are lower compared to those without PsA. A decrease in cardiovascular mortality from AMI in PsA reflects that even though PsA is associated with an increased prevalence of cardiovascular risk factors, the trends in mortality are similar or even better than those for the general population.