POS0721 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)
Authors: I. Rúa-Figueroa, D. Rua-Figueroa, A. M. Anzola Alfaro, N. Pérez-Veiga, M. Galindo-Izquierdo, J. Calvo-Alén, A. Fernandez-Nebro, R. Menor-Almagro, C. Sanguesa, E. Tomero Muriel, N. Del-Val, E. Uriarte Isacelaya, R. Blanco, A. Boteanu, J. Narváez, J. L. Andréu Sánchez, T. Cobo-Ibáñez, C. A. Montilla-Morales, M. Freire González, C. Bohórquez, F. J. Toyos Sáenz de Miera, E. Salas, J. A. Bernal, E. Salgado Perez, L. Expósito, A. J. Mas, J. A. Hernandez Beriain, M. Velloso Feijoo, N. Lozano Rivas, G. Bonilla, V. Quevedo Vila, M. Moreno, I. Jiménez-Moleón, O. Ibarguengoitia, A. Pecondon, E. Aurrecoechea, E. Valls-Pascual, C. Mouriño, T. R. Vazquez Rodriguez, J. M. Pego-Reigosa
Journal: Annals of the Rheumatic Diseases (2021)

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&lt;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&lt;0.0001]. The results of the multivariable model are depicted in table 1. Table 1. Congestive heart failure associated factors (multivariable analysis) Odds Ratio 95% CI P-value Sex (female) 0.46 0.25 - 0.88 0.0147 Ischaemic cardiopathy 7.96 4.01 - 15.48 &lt;0.0001 Cardiac arrhythmia 7.38 4.00 - 13.42 &lt;0.0001 Pulmonary hypertension 3.71 1.84 - 7.25 0.0002 Cardiac valvulopathy 6.33 3.41 - 11.62 &lt;0.0001 Hospitalization (due to SLE) 3.74 1.81 - 8.65 0.0008 Calcium or vitamin D 5.29 2.07 - 16.86 0.0015 Antimalarials 0.28 0.17 - 0.45 &lt;0.0001 mSDI * 1.29 1.16 - 1.44 &lt;0.0001 *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