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Subtypes of Heart Failure in Autoimmune Diseases

      Background: Autoimmune diseases (AD) are thought to increase the risk of cardiovascular disease (CVD) through chronic inflammation and accelerated atherosclerosis. While heart failure (HF) has been described in a number of AD, little is known about HF subtypes. We sought to investigate the risk of HF and its subtypes among AD in large, real-world cohorts. Methods: Using an aggregated database (Explorys, Cleveland, OH), AD with cohort size >7,000 and known association with CVD were included for analysis. Ischemic cardiomyopathy (ICM) was defined as co-presence of HF and coronary artery disease (CAD), while non-ischemic cardiomyopathy (NICM) was defined as HF without CAD. Systolic HF and diastolic HF (without coexisting systolic HF) were used to represent HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), respectively. Cohorts were examined for prevalence and distribution of HF and its subtypes. Results: Thirteen autoimmune cohorts were examined: dermatomyositis (n = 11,100, female proportion (F):63.7%, HF prevalence:19.8%), polymyositis (n = 17,290, F:64.4%, HF:19.2%), rheumatoid arthritis (n = 368,300, F:74.7%, HF:17.0%), systemic sclerosis (n = 20,970, F:85.0%, HF:17.0%), granulomatosis with polyangiitis (n = 7,050, F:55.9%, HF:15.6%), systemic lupus erythematosus (SLE) (n = 124,190, F:87.1%, HF:15.4%), myasthenia gravis (n = 18,670, F:55.3%, HF:14.5%), celiac disease (n = 83,100, F:74.7%, HF:10.6%), ankylosing spondylitis (n = 25,450, F:45.8%, HF:10.1%), psoriasis (n = 230,290, F:51.1%, HF:7.6%), Crohn's disease (n = 168,450, F:50.0%, HF:5.8%), ulcerative colitis (n = 179,160, F:71.6%, HF:5.8%), and autoimmune thyroiditis (n = 118,660, F:87.0%, HF:4.4%). Risk of HF was greater for males than females, with highest relative risk (RR) seen in SLE (RR:2.13), except in Crohn's disease (RR:0.66). In all cohorts, ICM was more common than NICM, and HFpEF was more common than HFrEF. Celiac disease was an outlier with disproportionately high proportion of ICM over NICM (Fig. 1). Conclusion: HF is prevalent in many autoimmune diseases. In general, males are at higher risk than females, and ICM and HFpEF are more common than NICM and HFrEF, respectively.