The presentation and outcome of heart failure in patients with rheumatoid arthritis differs from that in the general population
The presentation and outcome of heart failure in patients with rheumatoid arthritis differs from that in the general population
复制标题
DOI：
10.1002/art.23798
复制
发表时间：
2008-09-01
影响因子：
--
通讯作者：
Gabriel, Sherine E.
中科院分区：
文献类型：
--
作者：
Davis, John M., III;Roger, Veronique L.;Gabriel, Sherine E.
客观的。比较类风湿性关节炎 (RA) 患者与非 RA 患者心力衰竭的临床表现、治疗和结果。方法。我们从 1979 年到 2000 年在明尼苏达州奥姆斯特德县进行了一项基于社区的队列研究。对 103 名 RA 患者和 852 名发生心力衰竭的非 RA 患者（经医生诊断和弗雷明汉标准验证）进行了比较。使用年龄和性别调整率/频率和多变量逻辑回归模型来比较两组患者心力衰竭的临床特征和死亡率。结果。 RA 患者多为女性，肥胖、高血压或缺血性心脏病的患者较少。与非 RA 患者相比，RA 合并心力衰竭患者的典型症状和体征较少，且接受超声心动图检查的可能性较小。调整差异后，患有 RA 和心力衰竭的患者更有可能保留射血分数 (>= 50%)。与非 RA 患者相比，RA 患者心力衰竭后 I 年的死亡率较高（35% 对比 19%；多变量风险比 1.89，95% 置信区间 1.26-2.84）。结论。同一人群中患有 RA 的患者与未患有 RA 的患者之间，心力衰竭的临床表现和结果均存在显着差异。在RA患者中，心力衰竭的表现更加微妙，心肌功能更有可能得到保留，而心力衰竭的死亡率则明显更高。这些发现强调了对 RA 患者进行更警惕的心力衰竭早期症状筛查的重要性，并且可能代表了对 RA 心力衰竭潜在生物学机制的重要见解。
Objective. To compare the clinical presentation, management, and outcome of heart failure in patients with rheumatoid arthritis (RA) compared with non-RA patients.Methods. We conducted a community-based cohort study in the setting of Olmsted County, Minnesota, from 1979 to 2000. One hundred three patients with RA and 852 non-RA patients with incident heart failure (physician diagnosed and Framingham criteria validated) were compared. Age- and sex-adjusted rates/frequencies and multivariable logistic regression models were used to compare the clinical features and mortality of heart failure following its onset in the 2 groups of patients.Results. The patients with RA were more often female and less frequently were obese, were hypertensive, or had ischemic heart disease. Patients with RA and heart failure had fewer typical symptoms and signs and were less likely to undergo echocardiography compared with non-RA patients. After adjusting for differences, the patients with RA and heart failure were more likely to have preserved ejection fraction (>= 50%). Mortality at I year following heart failure was higher in patients with RA compared with non-RA patients (35% versus 19%; multivariable hazard ratio 1.89, 95% confidence interval 1.26-2.84).Conclusion. Both the clinical presentation and the outcome of heart failure differ significantly between patients with and those without RA from the same population. Among patients with RA, the presentation of heart failure is more subtle, myocardial function is more likely preserved, while mortality from heart failure is significantly higher. These findings emphasize the importance of more vigilant screening of patients with RA for early signs of heart failure and may represent important insights into the biologic mechanisms underlying heart failure in RA.