ARE ANTIMALARIALS SAFE FOR THE HEART OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS? ANALYSIS OF FACTORS ASSOCIATED WITH THE DEVELOPMENT OF HEART FAILURE IN PATIENTS IN THE SPANISH SOCIETY OF RHEUMATOLOGY LUPUS REGISTRY (RELESSER)
I. Rúa-Figueroa1, D. Rua-Figueroa2, A. M. Anzola Alfaro3, N. Pérez-Veiga4, M. Galindo-Izquierdo5, J. Calvo-Alén6, A. Fernandez-Nebro7, R. Menor-Almagro8, C. Sanguesa9, E. Tomero Muriel10, N. Del-Val11, E. Uriarte Isacelaya12, R. Blanco13, A. Boteanu14, J. Narváez15, J. L. Andréu Sánchez16, T. Cobo-Ibáñez17, C. A. Montilla-Morales18, M. Freire González19, C. Bohórquez20, F. J. Toyos Sáenz de Miera21, E. Salas22, J. A. Bernal23, E. Salgado Perez24, L. Expósito25, A. J. Mas26, J. A. Hernandez Beriain27, M. Velloso Feijoo28, N. Lozano Rivas29, G. Bonilla30, V. Quevedo Vila31, M. Moreno32, I. Jiménez-Moleón33, O. Ibarguengoitia34, A. Pecondon35, E. Aurrecoechea36, E. Valls-Pascual37, C. Mouriño38, T. R. Vazquez Rodriguez39, J. M. Pego-Reigosa38, on behalf of RELESSER and EAS-SER
1Hospital de Gran Canaria Doctor Negrin, Rheumatology, Las Palmas GC, Spain
2Hospital de Gran Canaria Doctor Negrin, Cardiology, Las Palmas GC, Spain
3Hospital Gregorio Marañón, Rheumatology, Madrid, Spain
4natalia.perez.veiga@gmail.com, Statistics, Las Palmas GC, Spain
5Hospital Doce de Octubre, Rheumatology, Madrid, Spain
6Hospital de Araba, Rheumatology, Vitoria, Spain
7Hospital Carlos Haya, Rheumatology, Malaga, Spain
8Hospital Jerez de la Frontera, Rheumatology, Jerez de la Frontera, Spain
9Hospital Germán Trias i Pujol, Rheumatology, Barcelona, Spain
10Hospital de la Princesa, Rheumatology, Madrid, Spain
11Hospital de Navarra, Rheumatology, Navarra, Spain
12Hospital Universitario Donostia, Rheumatology, San Sebastian, Spain
13Hospital Marqués de Valdecilla, Rheumatology, Santander, Spain
14Hospital Ramón y Cajal, Rheumatology, Madrid, Spain
15Hospital de Belvitge, Rheumatology, Barcelona, Spain
16Hospital Puerta de Hierro-Majadahonda, Rheumatology, Madrid, Spain
17Hospital Infanta Sofia, Rheumatology, Madrid, Spain
18Hospital de Salamanca, Rheumatology, Salamanca, Spain
19Complejo Hospitalario Universitario de A Coruña (CHUAC), Rheumatology, A Coruña, Spain
20Hospital Príncipe de Asturias, Rheumatology, Alcalá de Henares, Spain
21Hospital Virgen Macarena, Rheumatology, Sevilla, Spain
22Hospital Marina Baixa, Rheumatology, Villajoyosa, Spain
23Hospital de Alicante, Rheumatology, Alicante, Spain
24Complejo Hospitalario De Orense, Rheumatology, Orense, Spain
25Hospital Universitario de Canarias, Rheumatology, Tenerife, Spain
26Hospital Universitari Son Llàtzer, Rheumatology, Palma de Mallorca, Spain
27Hospital Insular de Gran Canaria, Rheumatology, Las Palmas GC, Spain
28Hospital de Valme, Rheumatology, Sevilla, Spain
29Hospital Virgen de la Arrixaca, Rheumatology, Murcia, Spain
30Hospital La Paz, Rheumatology, Madrid, Spain
31Hospital de Monforte, Rheumatology, Lugo, Spain
32Consorci Corporació Sanitària Parc Taulí, Rheumatology, Barcelona, Spain
33Hospital Clínico San Cecilio, Rheumatology, Granada, Spain
34Hospital de Basurto, Rheumatology, Bilbao, Spain
35Hospital Miguel Servet, Rheumatology, Zaragoza, Spain
36Hospital de Sierrallana, Rheumatology, Torrelavega, Spain
37Hospital Universitario Dr. Peset, Rheumatology, Valencia, Spain
38Galicia Sur Health Research Institute, Rheumatology, Vigo, Spain
39Hospital Lucus Augusti, Rheumatology, Lugo, Spain
Background: Factors associated with the development of chronic heart failure (CHF) in systemic lupus erythematosus (SLE) have received little attention. On the other hand, recent data from the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection during the COVID19 pandemic have cast some doubts on its cardiological safety.
Objectives: To identify factors associated to CHF in SLE.
Methods: Retrospective cross-sectional study, including all patients with SLE (≥4 ACR-1997 criteria) recruited in RELESSER registry. The objectives and methodology of the registry have been described previously (1). CHF was defined according to the Charlson index item. Patients with CHF before diagnosis of SLE were excluded. Cumulative damage was measured with the SLICC/ACR index, excluding cardiovascular (CV) items (mSDI). Multivariate analysis exploring factors associated with CHF was carried out.
Results: 117 patients (3% of the entire cohort) with SLE and CHF and 3,506 controls with SLE without CHF were included. 90% were women. Disease duration: mean (SD), 120.2 (87.7) months. CHF appeared after a median (P25-P75) of 9.40 (4.2-18.3) years from SLE diagnosis. Patients with CHF were older (59.8 ± 18.2 vs. 46.2 ± 4.3). In the bivariate analysis, the association of CHF with greater severity [Katz severity index: median (IQR): 4 (3-5) vs. 2 (1-3)], damage [mSDI: 3 (2-4) vs 0 (0-1)], comorbidity [modified Charlson- excluding CV items: 4 (3-6) vs 1(1-3)] and both CV (37.5% vs 6.7%) and overall mortality (43.2% vs 4.7%) (p<0.0001 for all comparisons). Also, CHF patients were more refractory to SLE treatments (33.3% vs 24%, p=0.0377) and were more frequently hospitalised due SLE [median 3 (1-5) vs 1(0-2), p<0.0001]. The results of the multivariable model are depicted in
table 1
.
*mSDI = modified SLICC/ACR damage index (without cardiovascular items)
Conclusion: - CHF is a rather late complication of SLE.
- Patients with SLE and CHF have more severe SLE, with greater refractoriness to SLE treatments and higher overall mortality.
- Treatment with antimalarials, as routinely used in SLE patients, is not only safe to heart, but even appears to have a cardioprotective effect.
REFERENCES:
[1]Rúa-Figueroa I, López-Longo FJ, Calvo-Alén J, et al. National registry of patients with systemic lupus erythematosus of the Spanish Society of Rheumatology: objectives and methodology. Reumatol Clin. 2014;10(1):17-24.
Acknowledgements: Research Unit of Spanish Society of Rheumatology
Disclosure of Interests: None declared
Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 610
Session: SLE, Sjögren’s and APS - clinical aspects (other than treatment)
(POSTERS only)
