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Disease Activity Linked to Heart Failure in Patients With Psoriatic Disease

Recent assessment has concluded that an increased risk of heart failure (HF) is linked to a combination of cardiovascular risk factors as well as onset of disease activity, particularly in nonischemic HF. This study evaluated incidences and risk factors for HF in patients with psoriatic disease (PsD) with a goal to define any electrocardiographic and echocardiographic findings.

A cohort analysis involving patients with PsD prospectively followed from 1978 to 2018 was conducted. Assessment was based on a standard protocol every 6 to 12 months. The primary outcome was the time to first event of HF, with a secondary outcome to further classify into ischemic vs nonischemic HF. Cox proportional hazards regression was used to evaluate the association between cardiovascular risk factors, measures of disease activity, and HF. Electrocardiographic and echocardiographic findings associated with HF events also were described.

Of the 1994 patients with PsD analyzed, 64 were reported to have experienced HF incidents (38 ischemic, 26 nonischemic). It was determined that the incidence rate of first HF event was 2.85 per 1000 patient years. With these HF incidents, it was found that atrial fibrillation (22%) and bundle branch blocks (29%) were the most common electrocardiographic findings. Additionally, the echocardiogram showed a 37% reduced ejection fraction and 63% preserved ejection fraction. Also, independent risk factors for all HF incidents underwent a multivariable analysis by health assessment questionnaire. It was revealed that these independent risk factors were ischemic with an adjusted mean (AM)-tender joint count, AM-swollen joint count, AM-erythrocyte sedimentation rate, AM-C-reactive protein, and physical function (all P<.05). Finally, it was noted that there were minimal disease activity state protections for all HF.

Reiterating that there is an increased risk of HF linked with known cardiovascular risk factors and disease activity especially in nonischemic HF, the study also concluded that inflammation on HF may be partially independent of atherosclerotic disease. —Jessica Garlewicz



Koppikar S, Colaco K, Harvey P, et al. Incidence of and risk factors for heart failure in patients with psoriatic disease - a cohort study. Arthritis Care Res (Hoboken). Published online February 11, 2021. doi:10.1002/acr.24578

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