As mentioned in a previous post, Rheumatoid Arthritis and Heart Disease, patients with RA have a significantly increased risk of heart attack and stroke and a shorter life expectancy as compared to the general population.  Rheumatoid arthritis may cause the the outer lining of the heart to swell (pericarditis) and cause heart complications. Inflammation of the heart muscle, called myocarditis, can also develop. Both of these conditions can lead to congestive heart failure (weakening of the heart’s pumping ability) which is more common among people with rheumatoid arthritis.

What is Congestive Heart Failure (also known simply as Heart Failure)?

The National Heart Lung and Blood Institute (NHLBI) shares key points related to heart failure:

 *  Heart failure is a condition in which your heart can't pump blood the way it should. In some cases, the heart can't fill with enough blood. In other cases, the heart can't send blood to the rest of the body with enough force. Some people have both problems.

 * "Heart failure" doesn't mean that your heart has stopped or is about to stop working. However, it's a serious condition that requires medical care.

 * The leading causes of heart failure are diseases that damage the heart. These include coronary artery disease, high blood pressure, and diabetes. Heart failure develops over time as the pumping action of the heart grows weaker.

 * Heart failure is a common condition. About 5 million people in the United States have heart failure, and it results in about 300,000 deaths each year. Heart failure is more common in people who are 65 or older, African American, or overweight or obese. Men have a higher rate of heart failure than women.

 * Common signs and symptoms of heart failure are shortness of breath or trouble breathing, fatigue (feeling tired), and swelling in the ankles, feet, legs, abdomen, and, rarely, the veins in the neck. All of these symptoms are due to fluid buildup in your body.

What is the risk of Congestive Heart Failure in patients with RA?

Researchers at the Mayo Clinic have observed that patients with RA have twice the risk of developing congestive heart failure as compared with persons without rheumatoid arthritis.  The excess risk stayed elevated even after researchers adjusted for common cardiovascular risk factors (i.e., hypertension, smoking, diabetes) and ischemic heart disease.  Most interesting is that the risk of congestive heart failure is higher in RA patients who are RF-positive than in those who are RF-seronegative.  This increased risk may be present at the earliest stages of the disease and may occur in the absence of obvious cardiovascular risk factors or ischemic heart disease.  See “The Risk of Congestive Heart Failure in Rheumatoid Arthritis: A Population-Based Study Over 46 Years.”

In a more recent study, the Mayo Clinic researchers found that RA patients with heart failure appear to have a more subtle presentation, with a lower frequency of typical heart failure symptoms and signs, as compared with non-RA patients with heart failure.  Mortality in the first year following heart failure is also higher in RA patients.  Their data suggests that new ways of screening for early left ventricular dysfunction in patients with RA should be investigated in order to optimize survival rates.  See “The Presentation and Outcome of Heart Failure in Patients With Rheumatoid Arthritis Differs From That in the General Population.”