Title: Heart Failure in Rheumatoid Arthritis: Rates, Predictors and the Effect of AntiTNF Therapy
1Heart Failure in Rheumatoid Arthritis Rates,
Predictors and the Effect of Anti-TNF Therapy
- Fred Wolfe Kaleb Michaud
- National Data Bank
- for Rheumatic Diseases
2Background
- RA is associated with increased CV mortality and
morbidity - TNF-alpha plays a role in normal and abnormal
cardiovascular physiology and pathology, and is a
potential factor in development of heart failure
(HF) - Trials in Class 3 and Class 4 HF have shown
worsening in HF when treated with Anti-TNF
therapy - FDA warns against use of TNF drugs in HF
- However, 50 of RA patients have evidence of CV
disease.
3Questions
- What is rate of HF in RA?
- Is it increased compared to general population
and other patients (OA)? - What are predictors of HF?
- What is the effect of anti-TNF therapy on
- Prevalent cases?
- Incident cases?
4Participants
- 13,171 RA participants in NDB
- Referred by community rheumatologists
- Completed 35,064 biannual questionnaires during
consecutive six-month assessment periods ending
in June 2002. - 2,568 patients osteoarthritis of the hip or knee
5Diagnosis of HF Screening
- History of preexisting cardiovascular illness,
current and previous hypertension, myocardial
infarction, and other cardiovascular conditions. - During the last 6 months were you diagnosed or
treated for HF? - Request and review records for all
hospitalizations. - Patients reporting HF were interviewed using a
standardized, written protocol.
6Valid Diagnosis of HF
- A diagnosis of HF was considered valid if the
patient provided data indicating that she was
told by a physician that she had HF and/or the
diagnosis was supported by medical records or
physician contact. Overall, reports of HF by
patients were confirmed in more than 90 of
cases.
7Statistical Methods
- Longitudinal DB (1-4) sequential obs
- Identified first HF () observation
- For HF (-), random observation
- Propensity scores
- HAQ, pain, global severity, prednisone use, age,
age squared, and sex. - Lagged predictors, sensitivity analyses
- Monte Carlo simulation to adjust OA pts
8(No Transcript)
9HF Rate in RA by Age and Sex
10Rates of HF in RA, OA and the General Population
11Predictors of HF in 13,171 Rheumatoid Arthritis
Patients
12Demographic Status of Anti-TNF and Control Groups
13Clinical Characteristics of Anti-TNF and Control
Groups
14Treatment Characteristics of Anti-TNF and Control
Groups
15Adjusted and Unadjusted Rates of Congestive Heart
Failure in RA According to Treatment Class All
Cases
16Adjusted and Unadjusted Rates of Congestive Heart
Failure in RA According to Treatment Class
Incident Cases
17Conclusion I
- The crude rate of HF in the RA is 3.5
- Rate is similar to that in general population,
but greater than rate in OA 2.2 - HF risk factors in RA similar to general
population - Hypertension, prior myocardial infarction,
diabetes, advanced age, BMI, education, smoking - HAQ
- Crude rates of prevalent HF cases were lower in
anti-TNF treated patients
18Conclusion II
- HF rates adjusted for risk of prescription by
propensity scores were also lower in anti-TNF
treated patients - The rate of incident cases was low (0.2) and was
not related to anti-TNF therapy. - Sensitivity analysis prior to FDA announcement
yielded similar results - In our analyses anti-TNF therapy is not
associated with increased risk of HF