What is the clinical evidence from this study?

Study design: Observational. Population: Rheumatoid arthritis and heart failure (n=31036). Intervention: Rheumatoid arthritis and heart failure. Primary outcome: Age-adjusted mortality rates (AAMR) and annual percent changes (APC) (APC 11.60, 95% CI 2.66-21.33).

What does this research mean for the field?

From 1999 to 2020, mortality in rheumatoid arthritis patients with heart failure declined until 2018 but then sharply rose, especially among females and older adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to analyze mortality trends in heart failure patients with rheumatoid arthritis over two decades to identify high-risk groups and inform public health strategies.

February 6, 2026

Data driven insights into heart failure mortality in rheumatoid arthritis: unveiling the cardiac burden: a two decade epidemiological study

Key Result

Age-adjusted mortality for rheumatoid arthritis and heart failure declined until 2018, before sharply rising (APC 11.60; 95% CI 2.66-21.33), with persistent demographic and geographic disparities.

Key Points

This research aims to analyze mortality trends in heart failure patients with rheumatoid arthritis over two decades to identify high-risk groups and inform public health strategies.
Utilized CDC WONDER mortality data from 1999 to 2020 for heart failure and rheumatoid arthritis identification.
Calculated age-adjusted mortality rates (AAMRs) per 1,000,000 using the 2000 U.S. standard population.
Employed joinpoint regression to estimate annual percent changes (APCs) in mortality rates.
Assessed demographic and geographic variables among adults aged 35 and older.
Identified 31,036 deaths related to rheumatoid arthritis heart failure from 1999 to 2020, with an overall AAMR of 8.33.
Mortality rates initially declined until 2009 but sharply increased after 2018, especially among females and the elderly.
Racial disparities noted, with American Indian/Alaskan Natives showing the highest AAMR (13.73) and Asian/Pacific Islanders the lowest (2.91).
Geographically, the Midwest had the highest AAMR (10.48), and most deaths occurred in medical facilities.

Study Design

Type

Observational (n=31,036)

Multicenter

Yes

Structured PICO

Population

31,036 deaths among adults ≥35 years with rheumatoid arthritis and heart failure in the United States from 1999 to 2020.

Outcome

Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) for RA-HF deathshard clinical

RA-HF mortality in the U.S. declined until 2018 but has recently risen sharply, highlighting the need for targeted public health strategies to address persistent demographic and geographic disparities.

Main Result

Effect estimate: APC 11.60 (95% CI 2.66-21.33)

Abstract

Abstract Introduction Rheumatoid arthritis (RA) doubles heart failure (HF) risk, contributing to high cardiovascular mortality in RA patients. Despite RA being linked to twice the HF incidence versus the general population, mechanisms remain unclear, and mortality trends in RA-HF patients are understudied. Purpose Analyze U.S. mortality trends (1999–2020) in RA-HF patients to identify high-risk groups and guide public health strategies. Methods CDC WONDER mortality data (ICD-10: HF=I50, I11.0, I13.0, I13.2; RA=M05, M06) were used. Age-adjusted mortality rates (AAMRs/1,000,000) calculated with 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs); significance (P0.05) determined via 95% CIs. Demographics (sex, age, race), geography (region, state, urban-rural), and place of death were assessed for adults ≥35 years (STROBE-compliant). Results From 1999–2020, 31,036 deaths occurred (AAMR:8.33). Mortality declined until 2009 (APC=−4.50, CI:−5.17–−3.81), then gradually until 2018 (APC=−0.71, CI:−1.73–0.32), before sharply rising (APC=11.60, CI:2.66–21.33). Females had higher AAMR (10.2) than males (5.4), with both showing initial declines followed by increases (males:2016, APC=4.49, CI:−0.38–9.60; females:2018, APC=12.80, CI:3.46–22.99). The 80–84 age group had the highest crude mortality (53.51). Racial disparities: American Indian/Alaskan Natives had highest AAMR (13.73), followed by non-Hispanic (NH) Whites (8.82), NH Blacks (8.71), and Asian/Pacific Islanders (2.91). Geographically, the Midwest had the highest AAMR (10.48), followed by West (9.30), South (7.43), and Northeast (6.34). North Dakota (18.57) and Nevada (3.15) had the highest and lowest state-level AAMRs, respectively. Non-core rural areas had the highest AAMR (12.07) versus large central metros (6.26). Most deaths occurred in medical facilities (10,291). Conclusion RA-HF mortality declined until 2020 but rose recently, notably among females and older adults. Persistent racial, geographic, and urban-rural disparities emphasize the need for equitable interventions to mitigate mortality.

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