Individuals with rheumatoid arthritis (RA) have an increased risk for hospitalization after receiving a diagnosis of heart failure (HF) compared with patients with HF but without RA. The main driver of this increased hospitalization risk in patients with RA appears to be attributable to non-cardiovascular (CV) causes, according to study results published in Seminars in Arthritis and Rheumatism.
Using the Rochester Epidemiology Project, researchers from the Mayo Clinic and Rutgers University retrospectively identified data comprising patients with incident HF from 1987 to 2012 and prior RA. The study included 212 patients with RA (mean age at HF diagnosis, 78.3±9.8 years) and 636 patients without RA (mean age at HF diagnosis, 78.6±9.7 years). Investigators followed patients until death, migration, or December 31, 2015, whichever came first, and conducted a retrospective medical records review to identify risk factors for hospitalization in both patient groups.
Investigators observed a higher hospitalization rate in patients with RA vs patients without RA after HF diagnosis (100.2 hospitalizations/100 person-years vs 86 hospitalizations/100 person-years, respectively; rate ratio [RR] 1.17; 95% CI, 1.08-1.26). They observed a similar increase in hospitalization risk across both sexes and all ages.
Hospitalization risk was more likely to be related to non-CV causes (RR 1.26; 95% CI, 1.14-1.39) but not for HF (RR 0.96; 95% CI, 0.75-1.2) or other CV causes (RR 0.99; 95% CI, 0.81-1.2) compared with patients without RA. Additional risks for hospitalization in patients with RA included current or former smoking (hazard ratio [HR] 1.33; 95% CI, 1.06-1.68), prior myocardial infarction (HR 1.37; 95% CI, 1.03-1.82), and higher Charlson Comorbidity Index values (HR 1.1; 95% CI, 1.06-1.14).
Study limitations included its observational nature and the lack of information on antirheumatic medications.
Findings from this study suggest that “increased management complexity among patients with comorbid RA may play a role in more frequent hospitalizations in patients with RA and HF.”
Myasoedova E, Davis JM, Matteson EL, et al. Increased hospitalization rates following heart failure diagnosis in rheumatoid arthritis as compared to the general population [published online July 15, 2019]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2019.07.006