The following is a summary of “Trends in Incidence of Chronic Heart Failure in Patients With Rheumatoid Arthritis: A Population-Based Study Validating Different Heart Failure Definitions,” published in the July 2023 issue of Rheumatology by Myasoedova et al.
This study aims to evaluate trends in the incidence of heart failure (HF) in patients with incident rheumatoid arthritis (RA) from 1980 to 2009 and to compare various HF definitions in RA. Residents of Olmsted County, Minnesota, with incident RA (age 18 years, 1987 American College of Rheumatology criteria met in 1980-2009) constituted the study population. All subjects were followed until death, migration, or 30 April 2019, whichever came first. The definition of incident HF events was as follows: meeting the Framingham criteria for HF, a physician’s diagnosis of HF (outpatient or inpatient), or the presence of ICD-9 or ICD-10 codes for HF.
Before the RA incidence/index date, patients with HF were excluded. Adjusting for age, gender, and cardiovascular risk factors, researchers used Cox proportional hazards models to compare incident HF events by decade. Framingham criteria were compared to HF definitions 2 and 3. The study included 905 rheumatoid arthritis (RA) patients (mean age 55.9 years; 68.6% female; median follow-up 13.4 years). In the 1980s, the 10-year cumulative incidence of HF events in the RA cohort was 11.66% (95% CI: 7.86-17.29); in the 1990s, it was 12.64% (95% CI: 9.31-17.17), and in the 2000s it was 7.67% (95% CI: 5.36-10.97).
Using any of the HF definitions, the incidence of HF did not change over the decades that RA incidence increased. Compared to the Framingham criteria, physician diagnosis of HF and ICD-9/10 code-based definitions of HF performed well, demonstrating moderate to high sensitivity and specificity. The incidence of HF in patients with incident RA did not differ statistically significantly between the 2000s and 1980s. By the Framingham criteria, physician diagnosis and ICD-9/10 codes for HF performed well.