The clinical presentation and outcome of heart failure differ significantly in patients who have rheumatoid arthritis (RA) and those who do not.The presentation of heart failure is more subtle in patients with RA, and mortality is significantly higher.
Davis and associates conducted a community-based cohort study comparing 103 patients with RA and 852 patients without RA who had heart failure. They collected clinical data about the clinical presentation, echocardiographic data, and information on the use of medications (angiotensin-converting enzyme [ACE] inhibitors and β-blockers).
The patients with RA were less likely to present with paroxysmal nocturnal dyspnea, hepatojugular reflux, dyspnea on exertion, and orthopnea; significantly more likely to have rales; and far less likely to present with elevated systolic or diastolic blood pressure. They were less likely to have undergone echocardiography. Their mean ejection fraction was significantly higher. Patients with RA and heart failure received treatment with ACE inhibitors and β-blockers less frequently. Mortality was higher 30 days and 1 year after the onset of heart failure.
The authors noted that these findings emphasize the importance of more vigilant screening of patients who have RA for early signs of heart failure and may represent important insights into underlying mechanisms.