Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

Abstract

Background Rheumatoid arthritis ( RA ) is a chronic inflammatory disease associated with a wide range of comorbidities, including cardiovascular disease, but its association with heart failure ( HF ) is not fully clear. We investigated the risk of incident HF in a nationwide cohort of patients with RA . Methods and Results The study comprised the entire Danish population aged ≥18 years followed from January 1, 2008 until first hospitalization for HF , emigration, December 31, 2012, or death. Information on comorbidity, medication, and socioeconomic status was identified by individual‐level linkage of administrative registers. Patients with a rheumatologist diagnosis of RA between 1978 and 2008 were included. The primary study outcome was incident HF defined as first hospital admission for HF . Incidence rates of HF per 1000 person‐years were calculated and incidence rate ratios adjusted for age, sex, calendar year, comorbidity, medications, socioeconomic status, smoking, and alcohol consumption were estimated. A total of 4 305 225 subjects with no history of HF were eligible for analysis at the study start. Of these subjects, 24 343 developed RA and 50 623 were hospitalized for HF . Overall incidence rates of incident HF were 2.43 and 6.64 for the reference population (n=49 879) and patients with RA (n=744), respectively. Correspondingly, the fully adjusted incidence rate ratio for incident HF was increased in patients with RA with incidence rate ratio 1.30 (95% confidence interval, 1.17–1.45). Conclusions In this cohort study, RA was associated with an increased hospitalization for HF . These findings add significantly to the existing evidence of RA as a clinically relevant risk factor for HF .