Association of systemic sclerosis with incident clinically evident heart failure

Primary myocardial involvement is an important cause of death in systemic sclerosis (SSc). Subclinical diastolic/systolic heart dysfunction is recognized; however, whether this indicates a subsequent increased risk of clinically overt heart failure (HF) remains largely unknown. We aimed to investigate the risk of clinically overt HF in a large, unselected SSc cohort.This matched retrospective cohort study was conducted using a nationwide insurance database in Taiwan. Incident SSc patients with no history of HF were identified, and non-SSc comparison groups were selected and matched to the SSc groups by age, sex, and cohort entry time. The cumulative HF incidence was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards regression was used to calculate adjusted hazard ratios (HRs) for HF hospitalization.A total of 1830 SSc patients and 27,981 controls were identified. The cumulative incidence of hospitalized HF at 3, 5, and 10 years among patients with SSc were 3.5%, 5.3%, and 9.7%, respectively. Compared with non-SSc individuals, SSc patients had an increased risk of HF (adjusted HR: 3.26, 95% confidence interval [CI]: 2.49-4.28). Subgroup analyses revealed that the impact of SSc on the occurrence of HF was greater among patients aged50 years than those aged ≥50 years (HR: 7.8, 95% CI: 4.03-15.1 versus HR: 2.78, 95% CI: 2.06-3.76).SSc is associated with a markedly higher risk of clinically evident HF, and not asymptomatic ventricular dysfunction alone. These findings provide real-world evidence suggesting the use of appropriate screening strategies to detect these lethal complications early in SSc. This article is protected by copyright. All rights reserved.