Risk of Incident Heart Failure and Heart Failure Subtypes in Patients With Rheumatoid Arthritis

OBJECTIVE: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) including heart failure (HF). However, little is known regarding the relative risks of HF subtypes such as HF with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF) in RA compared with non-RA. METHODS: We identified patients with RA and matched non-RA comparators among participants consenting to broad research from two large academic centers. We identified incident HF and categorized HF subtypes based on EF closest to the HF incident date. Covariates included age, sex, and established CVD risk factors. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident HF and HF subtypes. RESULTS: We studied 1,445 patients with RA and 4,335 matched non-RA comparators (mean age 51.4 and 51.7 years, respectively; 78.7% female). HFpEF was the most common HF subtype in both groups (65% in RA vs 59% in non-RA). Patients with RA had an HR of 1.79 (95% confidence interval [CI] 1.38-2.32) for incident HF compared with those without RA after adjusting for CVD risk factors. Patients with RA had a higher rate of HFpEF (HR 1.99, 95% CI 1.43-2.77), but there was no statistical difference in the HFrEF rate (HR 1.45, 95% CI 0.81-2.60). CONCLUSION: RA was associated with a higher rate of HF overall compared with non-RA, even after adjustment for established CVD risk factors. The elevated risk was driven by HFpEF, supporting a role for inflammation in HFpEF and highlighting potential opportunities to address this excess risk in RA.