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Heart Failure in Rheumatoid Arthritis: Rates, Predictors and the Effect of AntiTNF Therapy

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Title: Heart Failure in Rheumatoid Arthritis: Rates, Predictors and the Effect of AntiTNF Therapy


1
Heart Failure in Rheumatoid Arthritis Rates,
Predictors and the Effect of Anti-TNF Therapy
  • Fred Wolfe Kaleb Michaud
  • National Data Bank
  • for Rheumatic Diseases

2
Background
  • 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.

3
Questions
  • 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?

4
Participants
  • 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

5
Diagnosis 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.

6
Valid 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.

7
Statistical 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)
9
HF Rate in RA by Age and Sex
10
Rates of HF in RA, OA and the General Population
11
Predictors of HF in 13,171 Rheumatoid Arthritis
Patients
12
Demographic Status of Anti-TNF and Control Groups
13
Clinical Characteristics of Anti-TNF and Control
Groups
14
Treatment Characteristics of Anti-TNF and Control
Groups
15
Adjusted and Unadjusted Rates of Congestive Heart
Failure in RA According to Treatment Class All
Cases
16
Adjusted and Unadjusted Rates of Congestive Heart
Failure in RA According to Treatment Class
Incident Cases
17
Conclusion 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

18
Conclusion 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
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