The association between osteoarthritis and invasive management strategies and clinical outcomes following acute myocardial infarction in electronic health record data

Parmar, Simran Singh

Abstract

Background
The association between osteoarthritis (OA) and acute myocardial infarction (AMI) is unclear, as are the outcomes of people with OA diagnosed with AMI. This study aimed to describe the annual prevalence of OA among AMI patients and describe the association between OA and invasive management strategies and adverse outcomes in AMI patients presenting to secondary care.

Methods
The National Inpatient Sample (NIS) was searched for all AMI hospitalisations between 2004 and 2015. The prevalence of OA among the AMI group was calculated. The proportion of patients receiving invasive management strategies (coronary angiography (CA), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG)) and experiencing adverse clinical outcomes (in-hospital mortality, major acute cardiovascular and cardiovascular events, all-cause bleeding, and stroke or TIA) was compared by OA status. Adjusted binary logistic regression determined the association between OA and each invasive management strategy and adverse clinical outcome.

Results
Of 6,561,940 hospitalizations for AMI between 2004 and 2015, 414,072 (6.3%) had a concurrent OA diagnosis. OA patients were older (mean: 75.3 versus 67.1 years, p<0.001) and more likely to be female (55.7% vs. 38.6%, p<0.001). OA was associated with a decreased odds of receiving CA (adjusted odds ratio 0.909; 95% confidence interval 0.903, 0.916), PCI (0.873; 0.866, 0.879), and CABG (0.983; 0.971, 0.996). OA was also associated with a decreased odds of adverse clinical outcomes (in-hospital mortality: 0.680; 0.670, 0.691; MACCE: 0.709; 0.699, 0.719; all-cause bleeding: 0.757; 0.741, 0.772; and stroke: 0.844; 0.822, 0.868).

Conclusion
A systematic differential misclassification bias, where unwell patients with OA were less likely to receive an OA code because codes for serious illness took precedence, is likely to explain the unexpected result of OA being associated with better outcomes following AMI. This bias should be considered when using electronic health record data to study the effects of comorbidities in unwell patients.

Citation

Parmar, S. S. (2020). The association between osteoarthritis and invasive management strategies and clinical outcomes following acute myocardial infarction in electronic health record data. (Thesis). Keele University

• Thesis Type: Thesis
• Publicly Available Date: May 30, 2023
• Award Date: 2020-12