Risk of Heart Failure Higher for Patients with Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) have an increased risk of heart failure independent of their increased risk of ischemic heart disease.

In a study published in the Journal of the American College of Cardiology, investigators sought to examine the relative risk of heart failure overall, and the subtype—–ischemic and nonischemic–– in patients with RA to assess the impact of RA disease factors.

The investigators identified 2 contemporary cohorts of RA subjects from Swedish patients and rheumatology registries, and matched 1:10 to general population comparator subjects. Through registry linkages, a first-ever heart failure diagnosis was assessed—–classified as ischemic heart failure or nonischemic heart failure—based on the presence of ischemic heart disease.

The results of the study showed that at the time of RA onset, a history of heart failure was not more common in RA. The overall HRs for subsequent heart failure (any type), ischemic heart failure, and non-ischemic heart failure were between 1.22 and 1.27 among new-onset RA patients.

The investigators observed a rapid increase in the risk of non-ischemic heart failure after onset of RA, in contrast to the risk of ischemic heart failure, according to the study.

Although the investigators found an association between high disease activity and all heart failure types, it was most pronounced for non-ischemic heart failure.

The HRs among the different heart failure subtypes were between 1.71 and 1.88 in the cohort of patients with RA of any duration, according to the study.

“Patients with RA are at increased risk of heart failure that cannot be explained by their increased risk of ischemic heart disease,” the authors wrote. “The increased risk of non-ischemic heart failure occurred early and was associated with RA severity.”