Incidence of Heart Failure In Rheumatoid Arthritis A Review of Literature And Meta-regression Analysis

• Published in: Journal of cardiac failure Vol. 26; no. 10; p. S36
• Main Authors: Khalid, Yaser, Dasu, Neethi, Shah, Ankit, Dasu, Kirti, Levine, Adam
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2020
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2020.09.109

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disorder that not only affects peripheral joints, but also increases risk for cardiovascular disease (CVD) and mortality. Heart failure (HF) appears to be one of the most important contributors to the excess mortality risk among patients with RA. We assessed the incidence of HF in patients with RA compared with age- and sex-matched non-RA subjects, after accounting for traditional CV risk factors and clinical ischemic heart disease. We performed aggregate analysis on three studies of RA patients having listed manifestations of HF. We performed a meta-regression analysis to evaluate the incidence of HF in RA patients with increased age and noted for any gender correlation. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using both fixed- and random-effects models. In the cumulative analysis of 5,220,883 patients, the incidence of HF was noted to be almost 2-fold higher in patients with RA compared to a matched control population (OR 1.78, 95% CI 1.22-2.60, p < 0.003), HTN (OR 1.66, 1.24-2.23, p < 0.001), and diabetes (OR 1.57, 1.36-1.81, p <0.001). Women had 3-fold higher incidence of HF with RA (OR 3.38, 95% CI: 2.59-4.40, p < 0.001). On meta-regression, the incidence of HF increased further with older age (coefficient = 0.12, p = 0.0004). Our systematic review included over 5 million subjects confirms the suspected increased incidence of HF in RA patients. Women have the greatest risk for HF. Our analysis advocates the need for updating the current guidelines to incorporate screening and preventive methods for HF in RA patients.