1
|
Goulabchand R, Qian AS, Nguyen NH, Singh AG, Roubille C, Parreau S, Singh N, Singh S. Burden, Causes, and Outcomes of Hospitalization in Patients With Giant Cell Arteritis: A US National Cohort Study. Arthritis Care Res (Hoboken) 2023; 75:1830-1837. [PMID: 36576029 PMCID: PMC10300231 DOI: 10.1002/acr.25081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/07/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Giant cell arteritis (GCA) has a relapsing-remitting course and is associated with a high burden of comorbidities, leading to repeated hospitalizations. This study was undertaken to investigate the burden, risk factors, causes, and outcomes of hospitalization and readmission in GCA patients in a US national cohort. METHODS Using the 2017 US National Readmission Database, we identified adults ≥50 years of age hospitalized with GCA between January and June 2017, with at least 6 months of follow-up. We estimated the burden of hospitalization including 6-month risk of readmission, total days spent in hospital, and costs, annually. We examined patient-, hospital-, and index hospitalization-related factors for 6-month readmission and total days of hospitalization using binomial logistic regression. RESULTS Our study included 1,206 patients hospitalized with GCA (70% women, median age 77 years), with 13% of patients experiencing GCA-related ophthalmologic complications at index hospital admission. On follow-up, 3% died, and 34% of patients were readmitted within 6 months, primarily for infections (23%) and cardiovascular diseases (CVDs) (15%). Charlson comorbidity index (CCI) of ≥1, smoking, and obesity were associated with readmission. GCA patients spent a median of 5 days/year in hospital (interquartile range [IQR] 3-11), with those in the top quartile spending 19 days/year in hospital (IQR 14-26). CONCLUSION GCA patients frequently experience unplanned health care utilization, with 1 in 3 patients experiencing readmission within 6 months, and 3% dying within the follow-up period. Infection and CVDs are common causes of readmission and may be related to glucocorticoid exposure. Population health management strategies are required in these vulnerable GCA patients.
Collapse
Affiliation(s)
- Radjiv Goulabchand
- Radjiv Goulabchand, MD, PhD: CHU Nimes, University of Montpellier, Nîmes, France, and University of California San Diego, La Jolla
| | - Alexander S. Qian
- Alexander S. Qian, MD, Nghia H. Nguyen, MD, Abha G. Singh, MD, Camille Roubille, MD, PhD, Siddharth Singh, MD, MS: University of California San Diego, La Jolla
| | - Nghia H. Nguyen
- Alexander S. Qian, MD, Nghia H. Nguyen, MD, Abha G. Singh, MD, Camille Roubille, MD, PhD, Siddharth Singh, MD, MS: University of California San Diego, La Jolla
| | - Abha G. Singh
- Alexander S. Qian, MD, Nghia H. Nguyen, MD, Abha G. Singh, MD, Camille Roubille, MD, PhD, Siddharth Singh, MD, MS: University of California San Diego, La Jolla
| | - Camille Roubille
- Alexander S. Qian, MD, Nghia H. Nguyen, MD, Abha G. Singh, MD, Camille Roubille, MD, PhD, Siddharth Singh, MD, MS: University of California San Diego, La Jolla
| | - Simon Parreau
- Simon Parreau, MD, MSCI: Limoges University Hospital Center, Limoges, France
| | - Namrata Singh
- Namrata Singh, MD, MSCI: University of Washington, Seattle
| | - Siddharth Singh
- Alexander S. Qian, MD, Nghia H. Nguyen, MD, Abha G. Singh, MD, Camille Roubille, MD, PhD, Siddharth Singh, MD, MS: University of California San Diego, La Jolla
| |
Collapse
|
2
|
Michailidou D, Zhang T, Stamatis P, Ng B. Risk of venous and arterial thromboembolism in patients with giant cell arteritis and/or polymyalgia rheumatica: A Veterans Health Administration population-based study in the United States. J Intern Med 2022; 291:665-675. [PMID: 34982490 DOI: 10.1111/joim.13446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are systemic inflammatory diseases that primarily affect elderly women. OBJECTIVES To compare the risk of thromboembolic events and retinal vascular occlusions in GCA and/or PMR with that in osteoarthritis (OA), evaluating a veteran-based population. METHODS A total of 1535 patients with GCA, 10,265 with PMR, and 1203 with overlapping disease, as well as 39,009 age- and sex-matched patients with OA were identified in this retrospective study. The incidence rate ratios (IRRs) of pulmonary embolism (PE), deep venous thrombosis (DVT), arterial thromboembolism, central retinal artery occlusion, and central retinal vein occlusion were calculated and examined over time. The cumulative incidence was plotted and hazard ratios (HRs) of thromboembolic events were calculated, adjusting for independent risk factors of thromboembolism. RESULTS Patients with GCA and overlapping disease exhibited higher IRRs for all thromboembolic events compared to patients with OA. Patients with GCA had a higher risk of developing DVT and retinal vascular occlusions than those with overlapping disease (HR: 2.01, 95% confidence interval [CI]: 1.35-2.99, p < 0.001; HR: 2.37, 95% CI: 1.23-4.53, p = 0.009, respectively) or PMR alone (HR: 1.89, 95% CI: 1.50-2.41, p < 0.001; HR: 4.68, 95% CI: 3.10-7.07, p < 0.001, respectively). Patients with GCA had a higher risk of developing PE than those with PMR (HR: 1.55, 95% CI: 1.1-2.18, p = 0.01). CONCLUSION The risk of thromboembolic events differs between GCA, PMR, and overlapping diseases. Our findings may help predict the risk of thromboembolic events based on disease phenotype.
Collapse
Affiliation(s)
- Despina Michailidou
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA.,Rheumatology Section, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Tianyu Zhang
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Bernard Ng
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA.,Rheumatology Section, VA Puget Sound Healthcare System, Seattle, WA, USA
| |
Collapse
|