RESEARCH - Heart failure more subtle and deadly in RA patients

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Heart Failure More Subtle and Deadly in Rheumatoid Arthritis Patients

NEW YORK (Reuters Health) Oct 03 - The initial signs and symptoms of

heart failure in patients with rheumatoid arthritis (RA) are less

obvious than those in patients without RA, and although myocardial

function is usually better preserved in RA patients, mortality is

higher, new research shows.

" It is conceivable that the subtle presentation of heart failure among

patients with RA leads to difficulty in diagnosis and influences

management, " Dr. M. , from the Mayo Clinic in Rochester,

Minnesota, and colleagues state.

Regarding the reduced survival seen in RA patients with heart failure,

the authors comment that " it may be anticipated that patients with

chronic systemic inflammatory diseases such as RA, who have markedly

elevated levels of inflammation mediators such as cytokines and

C-reactive protein, would, therefore, be at particularly high risk of

heart failure progression and, consequently, of higher mortality. "

The new findings, which appear in the September issue of Arthritis and

Rheumatism, stem from a community-based study of 103 RA patients and

852 patients without RA with incident heart failure who were living in

Olmsted County, Minnesota, from 1979 to 2000.

Compared with the non-RA patients, those with the disease were more

likely to be female, but less likely to be obese, hypertensive, or

have ischemic heart disease.

As noted, the usual signs and symptoms of heart failure were less

common in the RA group. In addition, RA patients were less likely than

their non-RA counterparts to undergo echocardiography.

Multivariate analysis showed that myocardial function was more likely

to be preserved (ejection fraction of 50% or higher) in RA patients.

Nonetheless, the 1-year mortality after heart failure in RA patients

was 35%, significantly higher than the 19% noted in non-RA patients

(HR = 1.89).

The findings suggest that clinicians need to be extra vigilant in

looking for the signs and symptoms of heart failure in RA patients,

the authors conclude.

Arthritis Rheum 2008;58:2603-2611.

http://www.medscape.com/viewarticle/581529

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