What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatoid Arthritis (n=905). Intervention: Incident RA in the 2000s vs. Incident RA in the 1980s. Primary outcome: 10-year cumulative incidence of heart failure events.

March 15, 2023Open Access

Trends in Incidence of Chronic Heart Failure in Patients With Rheumatoid Arthritis: A Population-Based Study Validating Different Heart Failure Definitions

Key Result

The 10-year cumulative incidence of heart failure in patients with incident rheumatoid arthritis was not statistically significantly different in the 2000s (7.67%) compared to the 1980s (11.66%).

Study Design

Type

Cohort (n=905)

Structured PICO

Did the incidence of heart failure in patients with rheumatoid arthritis change from 1980 to 2009, and how do different HF definitions compare?

Population

905 adults (age ≥ 18 years) with incident rheumatoid arthritis (1987 ACR criteria met in 1980-2009) in Olmsted County, Minnesota, mean age 55.9 years, 68.6% female.

Intervention

Decade of RA incidence (1990s and 2000s) and different HF definitions (physician diagnosis, ICD-9/10 codes)

Comparator

Decade of RA incidence in the 1980s and Framingham criteria for HF

Outcome

Incident heart failure eventshard clinical

The incidence of heart failure in patients with rheumatoid arthritis has not significantly improved over recent decades despite advances in RA treatment, and administrative codes or physician diagnosis are valid methods for identifying HF in this population.

Main Result

Absolute Event Rate: 7.67% vs 11.66%

Limitations

Predominantly White population in Olmsted County limits generalizability to more ethnically diverse populations.
Retrospective study design relies only on information available from medical records.
Inability to account for the use of over-the-counter nonsteroidal analgesics.
Lack of LVEF measures within 6 months of HF date in 20.3% of patients.
Did not collect information on medical therapies for HF or natriuretic peptide measurements.

Abstract

OBJECTIVE: To assess trends in the incidence of heart failure (HF) in patients with incident rheumatoid arthritis (RA) from 1980 to 2009 and to compare different HF definitions in RA. METHODS: The study population comprised Olmsted County, Minnesota residents with incident RA (age ≥ 18 yrs, 1987 American College of Rheumatology criteria met in 1980-2009). All subjects were followed until death, migration, or April 30, 2019. Incident HF events were defined as follows: (1) meeting the Framingham criteria for HF, (2) diagnosis of HF (outpatient or inpatient) by a physician, or (3) International Classification of Diseases, 9th revision (ICD-9), or ICD, 10th revision (ICD-10), codes for HF. Patients with HF prior to the RA incidence/index date were excluded. Cox proportional hazards models were used to compare incident HF events by decade, adjusting for age, sex, and cardiovascular risk factors. HF definitions 2 and 3 were compared to the Framingham criteria. RESULTS: The study included 905 patients with RA (mean age 55.9 years; 68.6% female; median follow-up 13.4 years). The 10-year cumulative incidence of HF events by any chart-reviewed method in the RA cohort in the 1980s was 11.66% (95% CI 7.86-17.29), in the 1990s it was 12.64% (95% CI 9.31-17.17), and in the 2000s it was 7.67% (95% CI 5.36-10.97). The incidence of HF did not change across the decades of RA incidence using any of the HF definitions. Physician diagnosis of HF and ICD-9/10 code-based definitions of HF performed well compared to the Framingham criteria, showing moderate to high sensitivity and specificity. CONCLUSION: The incidence of HF in patients with incident RA in the 2000s vs the 1980s was not statistically significantly different. Physician diagnosis of HF and ICD-9/10 codes for HF performed well against the Framingham criteria.

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