Long-term risk of heart failure in patients with autoimmune rheumatic diseases

Background: Rising evidence indicates that several autoimmune rheumatic diseases (ARDs) are associated with a higher risk of heart failure (HF); however, large-scale comparative studies across multiple ARDs are scarce. Methods: In this cohort study, participants without prevalent HF from the UK Biobank were included. The relation between ARDs and the incidence of HF and mortality was analyzed using Cox proportional hazards models. Results: Of 499,525 participants included in this study ( n = 10,198 with ARDs, n = 489,327 without ARDs), 18,686 HF cases occurred over a median follow-up of 13.8 years. Significantly elevated risks for HF were observed among all patients with ARDs ( P < 0.05), with the highest relative risk of HF in patients with systemic sclerosis (hazard ratio [HR]: 4.38; 95% confidence interval [CI]: 2.98–6.43; P < 0.001). Of patients who developed HF, those with ARDs exhibited a higher prevalence of rheumatic valvular disease (16.6% vs. 14.0%), non-rheumatic aortic valve disease (12.6% vs. 9.6%), and pulmonary heart disease (7.0% vs. 4.6%) before the diagnosis of HF ( P < 0.05), while the prevalence of coronary artery disease, atrial fibrillation/atrial flutter, and hypertensive heart disease was similar. A history of ARDs was associated with increased all-cause mortality after diagnosis of HF (HR: 1.32; 95% CI: 1.23–1.42; P < 0.001), especially for non-cardiovascular mortality (HR: 1.42; 95% CI: 1.30–1.56; P < 0.001). Conclusion: Various ARDs were associated with a higher risk of HF. Patients with HF and ARDs had a higher prevalence of valvular disease and pulmonary heart disease before HF diagnosis compared with other patients with HF. A history of ARDs was associated with higher mortality after diagnosis of HF.