Chronic Inflammatory Diseases Increase Heart Failure Risk

With a recent push to better understand the impact of systemic inflammation, results of a new study is shedding light on differential associations of chronic inflammatory diseases with incident heart failure.

Using data from electronic health records, investigators found rates of incident heart failure were increased across a slew of chronic inflammatory diseases, including systemic sclerosis, human immunodeficiency virus (HIV), and rheumatoid arthritis.

In an effort to compare the risk of incident heart failure across a multitude of chronic inflammatory diseases and determine if risks varied by severity of inflammation, a team led by investigators from the Feinberg School of Medicine designed the current study using electronic health record data from the Northwestern Medicine Enterprise Data Warehouse (NMEDW). From the database, investigators identified 37,636 subjects for their analysis—including 19,358 controls and 18,278 patients with chronic inflammatory disease in regular outpatient care.

Created in 2000, the NMEDW contains clinical data related to more than 6.6 million patients—the observation period for the current study ended January 1, 2019. Investigators pointed out all the patients included in the current analysis were at least 18 years old.

For the purpose of their analysis, investigators defined presence of systemic sclerosis, inflammatory bowel disease (IBD), and psoriasis as the presence of 2 or more ICD-9 or ICD10 diagnostic codes within a 2-year period. Additionally, systemic lupus erythematosus (SLE) required 3 diagnosis codes in 3 separate months, rheumatoid arthritis required 2 diagnostic codes and a prescription for disease-modifying antirheumatic drug, and HIV was based on serology and other factors.

Of the 18,278 patients with chronic inflammatory disease, 2715 had HIV, 5078 had IBD, 5365 had psoriasis, 3048 had rheumatoid arthritis, 801 had systemic sclerosis, and 1271 had SLE. Of note, controls without chronic inflammatory disease were frequency matched with patients with chronic inflammatory diseases based on age, sex, insurance status, baseline year, and baseline presence of hypertension and/or diabetes.

The primary outcome of the study was defined using validated inpatient or outpatient diagnostic codes. In secondary analyses, investigators used peak C-reactive protein (CRP) concentrations was proxies for inflammation severity and risks for heart failure using CRP tertiles—nadir CD4 was used as a marker of immune progression or disease severity in persons with HIV.

Over a follow-up period lasting a median of 3.6 years, a total of 1008 cases of incident heart failure were identified by investigators. Results of adjusted analyses indicated patients with systemic sclerosis (HR, 7.25; 95% CI, 5.71-9.21; P <.001), SLE (HR, 3.15; 95% CI, 2.41-4.11; P <.001), and rheumatoid arthritis (HR, 1.39; 95% CI, 1.13-1.71; P <.001) had significantly increased risk for incident heart failure. No significant association was observed between psoriasis and IBD an incident heart failure, but persons with HIV were at a borderline significantly elevated HF risk (HR, 1.28; 95% CI, 0.99-1.66; P <.06).

Of note, increased levels of CRP in patients with IBD or psoriasis were associated with higher heart failure risks than those in the control group. Furthermore, increased levels of nadir CD4 was associated with increased risk of heart failure in persons with HIV.

This study, “Differential Associations of Chronic Inflammatory Diseases With Incident Heart Failure,” was published in JACC: Heart Failure.