HF hospitalization risk greater in IMID patients

Patients with immune-mediated inflammatory disease (IMID) are at increased risk of hospitalization for heart failure (HF) when compared to the general population, reveals a study.

This population-based cohort study involved patients with rheumatoid arthritis (RA), radiographic axial spondyloarthritis (r-axSpA), psoriatic arthritis, and psoriasis in Ontario, Canada, from 2011 until 2019. In total, 243,061 patients with IMID and 748,517 with diabetes mellitus (DM) were included in the analysis, as well as 8,278,934 non-IMID, non-DM controls.

First hospitalization for HF was the primary outcome. The investigators calculated the incidence rates of HF for each cohort and the hazard ratios (HRs) for HF using Cox proportional hazard models. Finally, they classified the HF aetiology into mutually exclusive groups based on comorbidities during hospitalization.

In patients with IMID, the crude incidence rate for HF was 2.70 per 1,000 person-years, with the highest rate seen in those with RA and lowest in those with r-axSpA.

IMID patients also had a 34-percent higher risk of being hospitalized for HF than non-IMID comparators (HR, 1.34, 95 percent confidence interval [CI], 1.30‒1.38). Such risk was most pronounced among RA patients (HR, 1.61, 95 percent CI, 1.54‒1.68) and least noticeable in those with psoriasis (HR, 1.09, 95 percent CI, 1.03‒1.15).

On the other hand, the risk of HF hospitalization was substantially higher in patients with DM (HR, 2.19, 95 percent CI, 2.16‒2.21).

“The most common antecedent comorbidity associated with HF in all patients with IMID was ischaemic heart disease,” the investigators said. “In patients with IMID without DM, atrial fibrillation had a similar effect as ischaemic heart disease.”