Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy.
OBJECTIVE
We sought to determine the frequency of heart failure in patients with rheumatoid arthritis, and to determine its predictors, particularly the use of anti-tumor necrosis factor (TNF) therapy.


METHODS
Rheumatoid arthritis (n = 13,171) and osteoarthritis (n = 2568) patients were studied during a 2-year period ending in June 2002. The diagnosis of heart failure was based on self-report or review of medical records. Propensity scores were used to adjust for the risk of anti-TNF (infliximab and etanercept) prescription.


RESULTS
Heart failure was more common among patients with rheumatoid arthritis (3.9% [n = 461]) than in those with osteoarthritis (2.3% [n = 87]), after adjusting for differences in demographic characteristics. Patients with rheumatoid arthritis had similar risk factors for heart failure (e.g., hypertension, prior myocardial infarction, diabetes, advanced age) as persons in population-based studies. Heart failure was significantly (P <0.05) less common in anti-TNF-treated patients (3.1% [180/5832]) than in the remaining patients (3.8% [281/7339]), even after adjusting for baseline differences. In the absence of pre-existing cardiovascular disease, the risk of heart failure was low (0.4% [24/6251]) and was not related to anti-TNF therapy.


CONCLUSIONS
Our results suggest that rheumatoid arthritis increases the risk of heart failure, which may be ameliorated by anti-TNF therapies.
Arthritis Research Center Foundation, University of Kansas School of Medicine, Wichita 67214, USA. fwolfe@arthritis-research.org
Frederick
F
Wolfe
Kaleb
K
Michaud
D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D000068800:Etanercept; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept