Heart Failure Risk in Patients With Systemic Autoimmune Inflammatory Diseases

Cardiac disease, including heart failure (HF), is a significant cause of morbidity and mortality for patients with systemic autoimmune inflammatory diseases (SAIDs). We sought to describe HF risk among patients with SAIDs and to investigate associations between cardiovascular drug use and incident HF.

We conducted a retrospective cohort study of electronic health records of 182 795 adult patients with SAIDs including systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease, and HIV from 2000 to 2020 and track their risks of new-onset incident HF in a large multidisciplinary health care institution.

Systemic sclerosis (adjusted hazard ratio [aHR], 2.81 [95% CI, 2.57-3.08]; P<0.001), systemic lupus erythematosus (aHR, 1.64 [95% CI 1.56-1.74]; P<0.001), and rheumatoid arthritis (aHR, 1.54 [95% CI 1.47-1.61]; P<0.001), were significantly associated with incident HF compared both with a SAID-free control group and a large group with inflammatory bowel disease in adjusted Cox regression models. Beta-blocker use at baseline was associated with decreased incident HF in a combined group of systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis (aHR, 0.7 [95% CI 0.6-0.8]; P<0.001).

Patients with systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis had increased risk of incident HF independent of traditional risk factors, indicating an underlying autoimmune mechanism of cardiac involvement. Beta-blocker use was associated with decreased incident HF, indicating a potentially cardioprotective effect in SAIDs.