Heart failure more subtle, deadlier in arthritis

NEW YORK (Reuters Health) - The initial signs and symptoms of heart failure in people with rheumatoid arthritis are less obvious than in other patients, yet the death rate is higher, new research shows.

"It is conceivable that the subtle presentation of heart failure among patients with rheumatoid arthritis leads to difficulty in diagnosis and influences management," the researchers comment in their report in the medical journal Arthritis and Rheumatism.

Dr. John M. Davis, from the Mayo Clinic in Rochester, Minnesota, and colleagues based their findings on a study of people diagnosed with heart failure who were living in Olmsted County, Minnesota; 103 of them had rheumatoid arthritis and 852 did not.

As noted, the usual signs and symptoms of heart failure were less common in the rheumatoid arthritis group. In addition, arthritis patients were less likely to be checked out in detail by ultrasound examination of their hearts.

In fact, the hearts of people with rheumatoid arthritis were more likely than those of the others to have fairly well preserved pumping capacity. Nonetheless, the 1-year mortality rate after heart failure in arthritis patients was 35 percent, significantly higher than the 19 percent seen in non-arthritis patients.

The findings suggest that doctors need to be extra vigilant in looking for the signs of heart failure in people with rheumatoid arthritis, the authors conclude.

SOURCE: Arthritis and Rheumatism, September 2008.