Aims We investigated whether a diagnosis of rheumatoid arthritis (RA) affects the quality of inpatient acute myocardial infarction (AMI) care and long‐term mortality post‐AMI. Methods We analysed data from 784,091 adults, 6,047 with a diagnosis of RA, from England and Wales hospitalised with AMI between 2005 and 2019 from the MINAP registry, linked with ONS mortality data and Hospital Episode Statistics. Cox regression models were used to compare risk of all‐cause mortality at different time‐points according to presence of RA. Results There was no difference in adjusted thirty‐day mortality between groups (adjusted Hazard Ratio (aHR): 1.09, 95% CI 0.99‐1.19, P=0.075). Beyond this, at one‐year (aHR: 1.14, 95% CI 1.07‐1.21), five‐years, (aHR: 1.28, 95% CI 1.23‐1.33) and to the end of the study period (aHR: 1.31, 95% CI 1.26‐1.36), the risk of all‐cause mortality was significantly higher in patients with RA (all P<0.001). Risk of cardiovascular mortality was not significantly different at thirty‐days, or one‐year (aHR: 1.08, 95% CI 1.00‐1.17, P=0.058), but was at five‐years (aHR: 1.15, 95% CI 1.08‐1.23, P<0.001) and to the study endpoint post AMI (aHR: 1.18, 95% CI 1.11‐1.24, P<0.001). Conclusion We found no meaningful disparities in inpatient care according to the presence of RA, however, those with RA have elevated long‐term all‐cause mortality post‐AMI. Our findings suggest that the mortality burden of RA post‐AMI is not driven by the quality of AMI care during admission and is likely driven by the progressive nature of the comorbidities and the complications of treatments associated with RA.

image