Predictors of Mortality and In-Hospital Outcomes After Gastrointestinal Bleed in Patients With Rheumatoid Arthritis and Atrial Fibrillation on Long Term Oral Anticoagulants: A Propensity Score Matched Analysis

Gastrointestinal (GI) bleeding is a common and morbid complication in adults receiving long-term oral anticoagulation for atrial fibrillation (AF), and its impact may be amplified in patients with chronic systemic inflammatory diseases such as rheumatoid arthritis (RA). RA is associated with heightened cardiovascular risk, frailty, and immunosuppression, yet the prognostic significance of RA in anticoagulated AF patients hospitalized with GI bleeding has not been well defined. Using the 2016–2022 National Inpatient Sample, we examined adults with AF on long-term oral anticoagulants admitted for GI bleeding and compared outcomes between those with and without RA after propensity score matching and survey-weighted adjustment for baseline differences. We found that RA was associated with higher in-hospital mortality and greater odds of septic shock and respiratory compromise, while RA patients paradoxically had lower rates of acute ischemic stroke and a reduced need for blood transfusion, with no significant differences in hypovolemic shock, need for hemostasis, length of hospital stay, hospitalization costs, or nonhome discharge. Within the RA subgroup, markers of chronic frailty and acute organ failure, including unintentional weight loss, acute kidney injury, cardiogenic shock, ventricular fibrillation, and chronic liver disease, identified patients at particularly high risk for death. These findings highlight RA as a high-risk phenotype among anticoagulated AF patients with GI bleeding and underscore the need for aggressive surveillance and multidisciplinary management in this vulnerable population.