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Patients with rheumatoid arthritis may be at increased risk for heart failure
A higher prevalence of heart failure was seen in patients with rheumatoid arthritis compared to a cohort of participants without rheumatic diseases, according to a recently published study.
Researchers enrolled 157 patients with rheumatoid arthritis (RA) and 77 healthy participants matched for age and sex between April and June 2010. All participants were screened for cardiovascular (CV) risk factors and comorbidities through clinical examination, patient questionnaires, serological analysis and measurements of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) over the prior 24 months. Chest radiographs, ultrasound and electrocardiographs were obtained and spirometry, arterial blood gas analysis and urine analysis were performed. The Health Assessment Questionnaire was used to assess functional status. Framingham criteria was used to assess clinical signs and symptoms of heart failure (HF) and dyspnea on ordinary exertion was graded using New York Heart Association criteria.
The rate of HF in patients with RA was 24% compared to 6% in healthy participants. Diastolic HF was present in 23% of participants compared to systolic HF in 1% of patients. Clinical signs of HF were identified in 62% of patients with RA, while a diagnosis was made in 40% of patients and in 21% of control participants. Confirmation of HF was not confirmed in 60% of patients due to normal N-terminal pro B-type natriuretic peptide (NT-proBNP) and electrocardiograph. A third heart sound was detected in 50% of patients with RA, nocturia was identified in 48% and dyspnea in 42% of patients and these factors were more predictive of HF than edema, detected in 39%, or rales, identified in 38% of patients.
Diastolic dysfunction was identified in 59% of patients with RA compared to 39% of control participants, and women comprised a higher proportion of patients with HF. Patients with chronic kidney disease were more likely to have CV risk factors and tended to be older. Compared to patients with RA without HF, patients with HF showed a higher prevalence of disease severity based on disease activity scores and higher CRP values. – by Shirley Pulawski
Disclosure: The researchers report the study was supported by an unrestricted grant from Abbott Laboratories.