Cardiovascular
Risk of Heart failure in Patients With Rheumatoid arthritis: A Systematic Review and Meta-analysis of Cohort Studies Parkin Paramiraksa* Parkin Paramiraksa Metavee Boonsiri Poramin Patthamalai Amarit Tansawet
Objective
Rheumatoid arthritis (RA) is reported to be associated with an increased risk of incident cardiovascular diseases (CVD) including heart failure. However, the inconsistency remains among studies. Several systematic review and meta-analysis of cohort studies were conducted to estimate the risk of CVD in RA but did not include heart failure in the analysis. We aim to determine the risk of incident heart failure in RA patients.
Methods
A systematic search of MEDLINE, Scopus, EMBASE, Cochrane Library, and medRxiv was performed to identify relevant studies from inception to January 2024. The search terms were modified by each database. The eligible criteria are cohort studies reporting the risk of incident heart failure among populations with RA, compared with healthy control. Quality assessments were performed according to the Newcastle-Ottawa Scale (NOS). Screening, data extraction, and quality assessment were independently conducted by two reviewers. If consensus is required, the third reviewer will be consulted. The PRISMA and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. To minimize the effects of confounders, only adjusted hazard ratio (aHR), not crude HR, were pooled using the random-effects meta-analysis. Publication bias was evaluated by funnel plot.
Results
A total of 8 studies with 8 cohorts (n = 15,096,737 participants) met the eligibility criteria. The pooled aHR in the meta-analysis revealed a significant association between RA and risk of incident heart failure (pooled aHR, 1.41; 95% CI, 1.25-1.58). No evidence of publication bias was observed. Quality assessments of the included studies were high.
Conclusion
Patients with RA were at an increased risk of developing heart failure. RA patients with baseline risk of heart failure may require screening to early diagnosis and early treatment. Research exploring underlying mechanisms for the association of RA and incident heart failure is warranted.