Document Detail

The presentation and outcome of heart failure in patients with rheumatoid arthritis differs from that in the general population.
MedLine Citation:
PMID:  18759286     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the clinical presentation, management, and outcome of heart failure in patients with rheumatoid arthritis (RA) compared with non-RA patients.
METHODS: We conducted a community-based cohort study in the setting of Olmsted County, Minnesota, from 1979 to 2000. One hundred three patients with RA and 852 non-RA patients with incident heart failure (physician diagnosed and Framingham criteria validated) were compared. Age- and sex-adjusted rates/frequencies and multivariable logistic regression models were used to compare the clinical features and mortality of heart failure following its onset in the 2 groups of patients.
RESULTS: The patients with RA were more often female and less frequently were obese, were hypertensive, or had ischemic heart disease. Patients with RA and heart failure had fewer typical symptoms and signs and were less likely to undergo echocardiography compared with non-RA patients. After adjusting for differences, the patients with RA and heart failure were more likely to have preserved ejection fraction (>or=50%). Mortality at 1 year following heart failure was higher in patients with RA compared with non-RA patients (35% versus 19%; multivariable hazard ratio 1.89, 95% confidence interval 1.26-2.84).
CONCLUSION: Both the clinical presentation and the outcome of heart failure differ significantly between patients with and those without RA from the same population. Among patients with RA, the presentation of heart failure is more subtle, myocardial function is more likely preserved, while mortality from heart failure is significantly higher. These findings emphasize the importance of more vigilant screening of patients with RA for early signs of heart failure and may represent important insights into the biologic mechanisms underlying heart failure in RA.
John M Davis; Véronique L Roger; Cynthia S Crowson; Hilal Maradit Kremers; Terry M Therneau; Sherine E Gabriel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  58     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-08     Completed Date:  2010-03-31     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2603-11     Citation Subset:  AIM; IM    
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MeSH Terms
Age Factors
Aged, 80 and over
Arthritis, Rheumatoid / complications*,  epidemiology*
Cohort Studies
Heart Failure / complications*,  diagnosis,  epidemiology*
Kaplan-Meier Estimate
Middle Aged
Regression Analysis
Risk Factors
Sex Factors
Stroke Volume / physiology
Survival Rate
Treatment Outcome
Grant Support
AR-30582/AR/NIAMS NIH HHS; R01 AR046849/AR/NIAMS NIH HHS; R01 AR046849-06A1/AR/NIAMS NIH HHS; R01 HL072435/HL/NHLBI NIH HHS; R01 HL072435-06/HL/NHLBI NIH HHS; R01-HL-72435/HL/NHLBI NIH HHS; R01-R4-6849//PHS HHS
Comment In:
Arthritis Rheum. 2009 Jul;60(7):2206; author reply 2206-7   [PMID:  19565510 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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