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Research ArticleAccepted Article

Atrial Fibrillation/Flutter Hospitalizations among U.S. Medicaid Recipients with and without Systemic Lupus Erythematosus

Sarah K. Chen, Medha Barbhaiya, Daniel H. Solomon, Hongshu Guan, Kazuki Yoshida, Candace H. Feldman, Brendan M. Everett and Karen H. Costenbader
The Journal of Rheumatology November 2019, jrheum.190502; DOI: https://doi.org/10.3899/jrheum.190502
Sarah K. Chen
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Medha Barbhaiya
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Daniel H. Solomon
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Hongshu Guan
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Kazuki Yoshida
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Candace H. Feldman
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Brendan M. Everett
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Karen H. Costenbader
Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA. This work was funded by NIH R01 AR057327, K24 AR066109 (Dr. K Costenbader), NIH R56 HL134810 (Dr. B Everett) and NIH-P30-AR072577 (VERITY). Dr. SK Chen received research support from NIH T32 AR753033. Dr. Barbhaiya is supported by the Rheumatology Research Foundation Investigator Award. Dr. CH Feldman is supported by NIH K23 AR071500. She also receives research support from BMS and Pfizer for unrelated studies. Dr. B Everett’s work on this manuscript was supported by NIH R56 HL134810. He also reports grants and personal fees from Novartis, and personal fees from Amgen, NIDDK, Roche Diagnostics, U.S. FDA, and UpToDate. Dr. K Costenbader has received research support for this study from the NIH K24 AR066109 and R01 AR057327, and unrelated research support with Merck, Astra Zeneca, Glaxo Smith Kline. Sarah K. Chen, MD, corresponding author, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA 02115. Email schen30@bwh.harvard.edu
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Abstract

Objective Systemic lupus erythematosus (SLE) is a multi-system chronic inflammatory autoimmune disease with high prevalence of several risk factors for atrial fibrillation/flutter (AF). However, the incidence and risk of AF in SLE have not been well quantified.

Methods We used U.S. Medicaid Analytic eXtract from 2007-2010 to identify beneficiaries ages 18-65, with prevalent SLE, each matched by age and sex to four non-SLE general Medicaid recipients. We estimated the incidence rates (IR) per 1,000 person-years (PY) for AF hospitalizations and used multivariable Cox regression to estimate the hazard ratio (HR) for AF hospitalization.

Results We identified 46,876 U.S. Medicaid recipients with SLE, and 187,504 age- and sex-matched non-SLE controls (93% female; mean age 41.5+12.2). Known AF risk factors such as hypertension, cardiovascular disease (CVD) and kidney disease were more prevalent in SLE patients. During a mean follow-up of 1.9+1.1 years for SLE, and 1.8+1.1 years for controls, the IR per 1,000 PY for AF was 1.4 (95% CI 1.1-1.6) among SLE patients and 0.7 (95% 0.6-0.8) among non-SLE controls. In age- and sex- matched and race-adjusted Cox models, the HR for AF was 1.79 (95%CI 1.43-2.24); after adjustment for baseline hypertension and CVD, the adjusted HR was reduced to 1.17 (95%CI 0.92-1.48).

Conclusion SLE was associated with doubled rate of hospitalization for AF compared to age- and sexmatched general Medicaid patients. In a race-adjusted model, the risk was 80% higher. However, the AF risk factors hypertension and CVD were more prevalent among SLE patients and accounted for the excess risk.

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Accepted manuscript
Atrial Fibrillation/Flutter Hospitalizations among U.S. Medicaid Recipients with and without Systemic Lupus Erythematosus
Sarah K. Chen, Medha Barbhaiya, Daniel H. Solomon, Hongshu Guan, Kazuki Yoshida, Candace H. Feldman, Brendan M. Everett, Karen H. Costenbader
The Journal of Rheumatology Nov 2019, jrheum.190502; DOI: 10.3899/jrheum.190502

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Accepted manuscript
Atrial Fibrillation/Flutter Hospitalizations among U.S. Medicaid Recipients with and without Systemic Lupus Erythematosus
Sarah K. Chen, Medha Barbhaiya, Daniel H. Solomon, Hongshu Guan, Kazuki Yoshida, Candace H. Feldman, Brendan M. Everett, Karen H. Costenbader
The Journal of Rheumatology Nov 2019, jrheum.190502; DOI: 10.3899/jrheum.190502
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