RESEARCH - The presentation and outcome of heart failure in patients with RA differs from that in the general population

[Guest guest]

Arthritis Rheum. 2008 Sep;58(9):2603-11.

The presentation and outcome of heart failure in patients with

rheumatoid arthritis differs from that in the general population.

JM 3rd, VL, Crowson CS, Kremers HM, Therneau TM, SE.

Mayo Clinic, Rochester, Minnesota.

OBJECTIVE: To compare the clinical presentation, management, and

outcome of heart failure in patients with rheumatoid arthritis (RA)

compared with non-RA patients. METHODS: We conducted a community-based

cohort study in the setting of Olmsted County, Minnesota, from 1979 to

2000. One hundred three patients with RA and 852 non-RA patients with

incident heart failure (physician diagnosed and Framingham criteria

validated) were compared. Age- and sex-adjusted rates/frequencies and

multivariable logistic regression models were used to compare the

clinical features and mortality of heart failure following its onset

in the 2 groups of patients.

RESULTS: The patients with RA were more often female and less

frequently were obese, were hypertensive, or had ischemic heart

disease. Patients with RA and heart failure had fewer typical symptoms

and signs and were less likely to undergo echocardiography compared

with non-RA patients. After adjusting for differences, the patients

with RA and heart failure were more likely to have preserved ejection

fraction (>/=50%). Mortality at 1 year following heart failure was

higher in patients with RA compared with non-RA patients (35% versus

19%; multivariable hazard ratio 1.89, 95% confidence interval

1.26-2.84).

CONCLUSION: Both the clinical presentation and the outcome of heart

failure differ significantly between patients with and those without

RA from the same population. Among patients with RA, the presentation

of heart failure is more subtle, myocardial function is more likely

preserved, while mortality from heart failure is significantly higher.

These findings emphasize the importance of more vigilant screening of

patients with RA for early signs of heart failure and may represent

important insights into the biologic mechanisms underlying heart

failure in RA.

PMID: 18759286

http://www.ncbi.nlm.nih.gov/pubmed/18759286

--

Not an MD