Background/Purpose: Although rheumatoid arthritis (RA) is a known risk factor for heart failure (HF), a limited number of studies has explored the association based on HF subtype (ischemic and non-ischemic), RA serostatus, or use of biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). We aimed to evaluate the association between RA and subsequent risk of HF, focusing on ischemic and non-ischemic HF, as well as the role of RA serostatus (seropositive RA [SPRA] , seronegative RA[SNRA]) and the use of b/tsDMARDs.

Methods: This retrospective cohort study utilized nationwide population data from the National Health Insurance Service (NHIS) of Korea. The study analyzed 46,975 RA patients (33,424 SPRA, 13,551 SNRA) diagnosed in 2010–2017, along with 140,925 matched non-RA patients in a control group. Participants were followed from 1 year after RA diagnosis (to mitigate surveillance bias) until December 31, 2020. The primary outcome was newly diagnosed HF, classified as ischemic or non-ischemic.

Results: During follow-up, 615 new HF cases were identified (238 in the RA group, 377 in the control group). The RA patients had a higher risk of overall HF (adjusted hazard ratio (aHR) 1.97, 95% confidence interval (CI) 1.64-2.26), and risk was more prominent for ischemic HF (aHR 2.24, 95% CI 1.86-2.71) than non-ischemic HF (aHR 1.36, 95% CI 0.97-1.90). SPRA was associated with a higher risk than SNRA for overall HF (aHR 2.13, 95% CI 1.78-2.55 for SPRA and 1.59, 1.19-2.11 for SNRA compared to the control group) and non-ischemic HF (aHR 2.31, 95% CI 1.03-5.17 for SPRA and 0.71, 0.32-1.51 for SNRA) but not for ischemic HF (aHR 2.37 for SPRA and 1.94 for SNRA). Risk for HF was more prominent for bDMARD users than non-users for overall (aHR 3.16 vs. 1,89), ischemic (3.53 vs. 2.16), and non-ischemic HF (2.39 vs. 1.28). The effect of tsDMARDs could not be determined due to an insufficient number of HF events in these users.

Conclusion: This study demonstrates that RA was associated with both ischemic and non-ischemic HF, and that the association was stronger for ischemic HF. While the risk for ischemic HF was higher for both SPRA and SNRA, the risk for non-ischemic HF was higher only for SPRA and not for SNRA. bDMARDs do not seem to reduce but may instead increase the risk of HF.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-serologic-status-and-risk-of-heart-failure-a-national-cohort-study/