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Heart failure and left ventricular dysfunction in rheumatoid arthritis

Authors
Katherine P Liao, MD, MPH
Paul B Yu, MD, PhD, FAHA
Section Editor
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Deputy Editor
Paul L Romain, MD

INTRODUCTION

Heart failure (HF) is a common clinical syndrome that can result from a variety of structural or functional cardiac disorders. There is an increased incidence of HF in patients with rheumatoid arthritis (RA) compared with the general population, and HF may contribute to the shortened life expectancy observed in RA. In addition to symptomatic HF, asymptomatic left ventricular (LV) systolic dysfunction, defined by a reduced LV ejection fraction, is also more prevalent among patients with RA. Attempts to eliminate the risk of HF in patients with RA may significantly improve their survival.

Issues related to HF in patients with RA will be reviewed here. Other cardiac manifestations of RA and the issue of HF as a complication of targeted therapy directed against tumor necrosis factor (TNF)-alpha are presented separately. (See "Coronary artery disease in rheumatoid arthritis: Implications for prevention and management" and "Overview of the systemic and nonarticular manifestations of rheumatoid arthritis", section on 'Cardiac disease' and "Tumor necrosis factor-alpha inhibitors: An overview of adverse effects", section on 'Heart failure'.)

EPIDEMIOLOGY

Population-based studies — There are growing numbers of population-based estimates of the incidence, prevalence, and prognosis of heart failure (HF) in rheumatoid arthritis (RA) [1]. Data suggest that the incidence of HF in patients with RA is increased compared with a population of similar age and sex distribution without RA [2-5].

One study involved 575 patients with RA and 583 patients without RA [2,4]; the incidence of HF was significantly higher among patients with RA after adjustment for age, sex, known cardiovascular risk factors, and the presence of ischemic heart disease (1.99 versus 1.16 cases per 100 person-years, respectively).

In a second series, 603 patients with RA were compared with 603 controls without RA [3]. The cumulative incidence of HF but not ischemic heart disease was significantly higher in those with RA (37 versus 28 percent, at 30 years of follow-up).

                   

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Literature review current through: Nov 2016. | This topic last updated: Wed Dec 07 00:00:00 GMT+00:00 2016.
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