Risk of Incident Heart Failure and Heart Failure Subtypes in Patients with Rheumatoid Arthritis.

Abstract

Objective: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) including heart failure (HF). However, little is known regarding the relative risks of heart failure subtypes such as HF with preserved (HFpEF) or reduced ejection fraction (HFrEF) in RA compared to non-RA.

Methods: We identified RA patients and matched non-RA comparators among participants consenting to broad research from two large academic centers. We identified incident HF and categorized HF subtypes based on ejection fraction (EF) closest to the HF incident date. Covariates included age, sex, and established CVD risk factors. Cox proportional hazards models were used to estimate the hazard ratios (HR) for incident HF and HF subtypes.

Results: We studied 1445 RA patients and 4335 matched non-RA comparators (mean age 51.4 and 51.7 years, 78.7% female). HFpEF was the most common HF subtype in both groups (65% in RA vs. 59% in non-RA). RA patients had a HR of 1.79 (95% CI: 1.38-2.32) for incident HF compared to those without RA after adjusting for CVD risk factors. RA patients had a higher rate of HFpEF (HR 1.99, 95% CI: 1.43 - 2.77), but there was no statistical difference in HFrEF rate (HR 1.45, 95% CI 0.81 - 2.60).

Conclusion: RA was associated with higher rate of HF overall compared to non-RA, even after adjustment for established CVD risk factors. The elevated risk was driven by HFpEF, supporting a role for inflammation in HFpEF and highlighting potential opportunities to address this excess risk in RA.