Risk estimation for subclinical heart failure using the PREVENT calculator in patients with autoimmune rheumatic diseases

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Abstract Background Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and psoriatic arthritis (PsA) are heterogeneous autoimmune diseases with established cardiovascular involvement associated with a higher risk of developing heart failure (HF). Studies have shown a greater risk for HF in rheumatologic patients compared to the general population, however, the calculated risk varies among studies. PREVENTTM is the first cardiovascular risk calculator to predict the risk of HF. Purpose To evaluate the performance of the novel PREVENTTM cardiovascular risk calculator to detect subclinical HF in patients with inflammatory autoimmune diseases. Methods Cross-sectional, descriptive study involving RA, SLE, and PsA patients of a single cardiology-rheumatology preventive clinic in a tertiary-care hospital. This cohort includes patients aged 30-79 who met the ACR/EULAR/CASPAR classification criteria for diagnosing RA, SLE, and PsA, respectively. Exclusion criteria included a previous diagnosis of atherosclerotic cardiovascular disease, overlap syndromes, or pregnancy. The risk of heart failure was assessed using the new 10-year PREVENTTM calculator and patients were categorized as high risk if they had ≥20%. The result was multiplied by 1.5 according to EULAR 2015/2016 recommendations in the patients with RA. A transthoracic echocardiogram was performed on all participants by a board-certified cardiologist. Distribution was assessed by the Kolmogorov-Smirnov test. Results are shown as frequencies (%) for qualitative variables and mean ± SD or median (p25-p75) according to the distribution of quantitative variables. Cohen's Kappa coefficient was used to evaluate the agreement between the transthoracic echocardiogram and the PREVENTTM algorithm to detect subclinical HF. Results A total of 238 patients with rheumatic diseases were included, mostly women (n = 204, 85.7%) with a mean age of 52.8 ± 10.1 years. Demographic and clinical characteristics are shown in Table 1. The PREVENTTM calculator classified 4 (1.6%) patients of the 3 rheumatologic diseases as a high-risk category. Employing echocardiography, 144 (60.5%) patients with subclinical HF were identified. By Kappa analysis, a slight concordance was found in patients with RA (k = 0.033) and poor concordance in patients with SLE (k = -0.049) between the PREVENTTM algorithm and the echocardiogram for the classification of high-risk subclinical HF patients. No concordance was found in patients with PsA. Conclusion Our study demonstrates that the PREVENTTM risk algorithm failed to detect a high proportion of patients with subclinical HF and that there is no concordance between the two methods. Echocardiography as part of cardiovascular evaluation may help detect those patients with rheumatologic diseases and subclinical HF.