Decline in Excess Heart Failure Risk Observed Among Patients With vs Without Rheumatoid Arthritis

Compared with individuals without rheumatoid arthritis (RA), those with RA were found to have reduced excess heart failure (HF) in the 2000s vs 1980s; however, no statistically significant changes were observed with regard to incidence of HF between the 2 groups, according to study data presented at the European Alliance of Associations for Rheumatology (EULAR) 2021 Virtual Congress, held from June 2 to 5, 2021.

Heart failure is a common cardiovascular complication among patients with RA. Previous studies have indicated that patients with RA compared with the general population may have an elevated risk for HF.

To assess the risk for HF in patients with RA, researchers conducted a longitudinal study in Olmsted County, Minnesota between 1980 and 2009. Adults with incident RA were identified according to the American College of Rheumatology (ACR) criteria. Patients were matched with individuals without RA by age, sex, and calendar year of cohort entry. The primary study outcome was HF, defined using Framingham criteria. Patients with HF prior to RA diagnosis or cohort enrollment were excluded from the study. The 10-year cumulative incidence rate of HF was computed for each decade. Cox proportional hazard models were used to compare incident HF events by decade. Models were adjusted for age, sex, and known cardiovascular risk factors.

The RA cohort included 905 patients with a mean age of 55.9 years, among whom 69% were women. Median follow-up duration was 13.4 years. The 10-year cumulative incidence rates of HF were 8.5% (95% CI, 5.3%-13.6%), 10.8% (95% CI, 7.7%-15.1%), and 7.1% (95% CI, 4.9%-10.3%) in the 1980s, 1990s, and 2000s, respectively. Incidence rates were not significantly elevated in the 2000s and the 1990s compared with the 1980s.

The control cohort included 903 individuals without RA (mean age, 56.0 years; median follow-up time, 13.8 years; 69% women). Among these participants, the 10-year cumulative incidence rates for HF were 7.4% (95% CI, 4.5%-12.3%) in the 1980s, 7.5% (95% CI, 4.9%-11.3%) in the 1990s, and 7.3% (95% CI, 5.0%-10.7%) in the 2000s. Incidence rates for HF did not appear to change over time in the general population.

Patients with vs without RA had significantly elevated risk for HF in the 1980s (hazard ratio [HR], 2.20; 95% CI, 1.44-3.34) and in the 1990s (HR, 1.54; 95% CI, 1.04-2.29). However, in the 2000s, patients with RA had no excess risk for HF compared with the general population (HR, 1.14; 95% CI, 0.73-1.78).

Overall, the researchers noted, “We found a reduction in excess HF risk in patients with RA compared to individuals without RA in 2000s compared to 1980s. There were no statistically significant changes in incidence of HF in patients with RA and in individuals without RA over time. More studies are needed to understand the reasons and implications of these trends.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Myasoedova E, Davis JM III, Achenbach S, et al. Decline in excess risk of heart failure in patients with rheumatoid arthritis in recent years. Presented at: EULAR 2021 Virtual Congress; June 2-5, 2021. Abstract #OP0102.