medwireNews: People with newly-diagnosed polymyositis (PM) or dermatomyositis (DM) have a significantly higher 10-year risk for heart failure (HF) hospitalization than people who do not have these conditions, suggests research conducted in Taiwan.
Chun-Yu Lin (National Cheng Kung University, Tainan) and colleagues say their findings highlight the “need for increased vigilance and monitoring [of] patients with PM/DM for this potential lethal complication.”
Lin and team found that during a mean 5.3 years of follow-up, 4.4% of 2025 people were hospitalized for HF following a diagnosis of PM or DM between 2000 and 2013.
At the same time, the HF hospitalization rate was 1.4% among 196,109 controls without PM or DM who had 6.5 years of follow-up data, giving incidence rates of 8.3 and 2.2 cases per 1000 person–years, respectively.
After adjustment for age, sex, comorbidity, and medication use, the people with PM or DM had a significant 3.29-fold increased risk for HF relative to controls. This rose to a 3.59-fold increased risk when corticosteroid use was not included in the model.
The researchers also conducted a propensity score-matched analysis that resulted in 1997 pairs of PM or DM patients and controls.
In this analysis, the HF incidence rates were 8.4 and 4.7 cases per 1000 person–years in the PM/DM and control groups, respectively, resulting in a 2.06-fold increased risk with versus without PM or DM.
The cumulative incidence of HF in these matched individuals increased from 1.7% at 1 year to 3.3%, 4.4%, and 7.4% at years 3, 5, and 10, respectively, for those with PM or DM. For those without PM or DM, the corresponding rates were 0.75%, 1.5%, 2.3%, and 4.4%.
When looking at the unmatched cohort, the investigators found that the significantly increased risk for HF persisted among the people with PM or DM for at least 10 years and was highest during year 1. Specifically, the hazard ratios were 5.75, 4.59, 4.01, and 3.35 at years 1, 3, 5, and 10, respectively.
In the propensity score-matched cohort, the risk for HF remained approximately twofold higher with versus without PM or DM across all timepoints.
Writing in Arthritis & Rheumatology, Lin and co-authors suggest that the declining risk with time in the unadjusted model may be due, in part, to “subsequent controllable disease activity as well as to the reduction of corticosteroids dosage following appropriate treatment in some patients.”
They conclude by recommending “that rheumatologists regularly assess for associated symptoms and signs of HF during the clinical management of patients with PM/DM.”
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Arthritis Rheumatol 2021; doi:10.1002/art.41907