Patients with systemic sclerosis face ‘markedly higher risk’ for heart failure
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Patients with systemic sclerosis demonstrate a “markedly higher risk” for heart failure, but not asymptomatic ventricular dysfunction, compared with those without the disease, according to data published in Arthritis Care & Research.
“Although several studies have assessed the prevalence of primary myocardial damage in SSc, namely systolic or diastolic dysfunction, these studies were usually limited by their cross-sectional designs and a lack of well-matched control groups,” Chun-Yu Lin, MD, of the division of allergy, immunology and rheumatology at Kaohsiung Veterans General Hospital, in Taiwan, and colleagues, wrote. “Importantly, these previous studies did not adopt the occurrence of clinically evident [heart failure (HF)] as an outcome measure.”
To investigate the relationship between SSc and clinically evident heart failure, Lin and colleagues conducted a retrospective, longitudinal study. Data were drawn from the Taiwan National Health Insurance Research Database, which contains information on approximately 99% of the population of Taiwan, according to the researchers. To be included in the analysis, patients were required to be aged 18 years or older and have received an SSc diagnosis between Jan. 1, 2000, and Dec. 31, 2013.
Patients were excluded from the analysis if they had received diagnoses for other autoimmune diseases such as systemic lupus erythematosus, idiopathic inflammatory myopathy and rheumatoid arthritis.
The researchers randomly selected members of control cohort from the database based on patients who had never received a diagnosis for SSc, while index dates were randomly assigned and matched to the test group. The cohorts were additionally matched based on age and sex. The cohort entry date was defined as the day the patient received a diagnosis for SSc, and patients were followed until death, clinically evident heart failure, follow-up loss, or the end of the study, set at Dec. 13, 2013. The main outcome was first-time hospitalization for heart failure. That diagnosis was confirmed by way of code at the time of patient discharge.
The analysis included 1,830 patients with SSc and 27,981 matched controls. According to the researchers, the cumulative incidence of heart failure requiring hospitalization among patients with SSc was 3.5% at 3 years, 5.3% at 5 years and 9.7% at 10 years. The adjusted HR for heart failure among patients with SSc, compared with controls, was 3.26 (95% CI, 2.49-4.28). According to the researchers, the effect was more pronounced in patients aged 50 years and younger.
“This large-scale cohort study provided population-based evidence that patients with SSc express a markedly elevated risk of hospitalization for HF compared to the general population,” Lin and colleagues wrote. “These results bridge the gap between previous observations of subclinical heart dysfunction in SSc and clinically relevant HF.
“Considering the high mortality risk following HF hospitalization, our novel findings suggest that clinicians involved in the care of SSc patients should pay attention to associated symptoms and signs of HF,” they added.
References:
- Allanore Y, et al. Ann Rheum Dis. 2010;doi: 10.1136/ard.2008.103382.
- Bissell LA, et al. Rheumatology. 2017;doi: 10.1093/rheumatology/kew488.
- Rangarajan V, et al. Curr Opin Rheumatol. 2017;doi: 10.1097/BOR.0000000000000439.
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