Background/objectives Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. Methods Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. Results The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p<0.0001), cardiac arrhythmia (7.38 [4.00-13.42], p<0.0001), pulmonary hypertension (3.71 [1.84-7.25], p<0.0002), valvulopathy (6.33 [3.41-11.62], p<0.0001), non-cardiovascular damage (1.29 [1.16-1.44], p<0.000) and calcium/vitamin D treatment (5.29 [2.07-16.86], p=0.0015). Female sex (0.46 [0.25-0.88], p=0.0147) and antimalarials (0.28 [0.17-0.45], p<0.000) proved to be protective factors. Conclusions Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect.

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.Table 1.Congestive heart failure associated factors (multivariable analysis)Odds Ratio95% CIP-valueSex (female)0.460.25 - 0.880.0147Ischaemic cardiopathy7.964.01 - 15.48<0.0001Cardiac arrhythmia7.384.00 - 13.42<0.0001Pulmonary hypertension3.711.84 - 7.250.0002Cardiac valvulopathy6.333.41 - 11.62<0.0001Hospitalization (due to SLE)3.741.81 - 8.650.0008Calcium or vitamin D5.292.07 - 16.860.0015Antimalarials0.280.17 - 0.45<0.0001mSDI *1.291.16 - 1.44<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 RheumatologyDisclosure of Interests:None declared

BackgroundPatients with Systemic lupus erythematosus (SLE) have a well-known increased risk of major comorbidities, but they are also very heterogeneous in term of prevalence of comorbid conditions. The relationship of the comorbidities with the outcomes and the severity of index disease is less known.ObjectivesEvaluate the interactions between comorbid conditions, on a large multicenter SLE cohort from RELESSER register, and its impact in severity and outcomes.MethodsData about 14 cumulative comorbidities, as previously defined [1], where derived from patients with SLE (ACR-97 criteria) included in the retrospective phase of RELESSER. Severity Katz Index (SKI) and SLICC/ACR Damage Index (SDI) were calculated.An unsupervised cluster analysis using K-means method was implemented to define clusters. ANOVA and Tukey tests were used to compare continuous numerical variables; Kruskal-Wallis test to discrete variables and the Chi-square test (or Fisher’s exact test) to categorical ones.ResultsA total of 3658 SLE patients (ACR-97 criteria) were included. Median SKI: 2 (interquartile range (IQR):1-3); median SDI:1(IQR:0-2). Demographic data are shown in Table 1.The comorbidities considered and their prevalence were: Thyroiditis (8.3%), peptic ulcer (3.8%), severe hepatopathy (1.0%), obstructive pulmonary disease (2.7%), Diabetes (5.0%), cardiovascular event (CVE) (11.0%), cardiac arrhythmia (4.2%), pulmonary embolism (3.4%), dementia (0.7%), malignancy (5.9%); serious infection (19.3%), end stage renal disease (2.8%), osteoporosis (7.3%) and depression (17.1%).Four cluster, with markedly different comorbidity profiles and outcomes were identified (table 3): one subgroup was clustered around depression (100% of the cases) (cluster 2), another cluster (cluster 3) with>1 serious infection (100%) and cluster 4, with 100% of CVE. In cluster 1, no patient had any of the 3 defining comorbidities in the rest of the clusters. There were no statistically significant differences between clusters in death by SLE. The clusters are characterized in more detail in table 1, where a just summary of the main comorbidities included in the analysis is displayed.ConclusionCluster analysis identifies well-differentiated subgroups of SLE patients as regard comorbidities and associated mortality and severity of the disease.Reference[1]Rúa-Figueroa I 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.Table 1.Cluster of comorbidities and outcomes, N (%) unless specifiedCluster 1dCluster 2aCluster 3bCluster 4cp-valueAge, mean (SD)44.8 (14.1)49.8 (14.1)46.7 (14.3)46.7 (14.3)<0.001Male sex214 (9.2)a,c25 (4.8)51 (12.2)a63 (16.3)a,d<0.001Time with SLE (years), mean (SD)129.2 (95.9)159.3 (101.4)d170.3 (100.3)d169 (113)d<0.001Cardiovascular event0 (0)c0 (0)c0 (0)c388 (100)<0.001Cardiac arrhythmia53 (2.3)b,c17 (3.3)c19 (4.5)c,d61 (15.7)<0.001Malignancy110 (4.7)a,c46 (8.9)d25 (6.0)31 (8.0)d0.001Serious infection0 (0)122 (23.6)418 (100)165 (42.5)<0.001End stage renal disease27 (1.2)b,c11 (2.1)b,c26 (6.2)a,d34 (8.8)a,d<0.001Osteoporosis79 (3.4)71 (13.8)d41 (9.8)c,d69 (17.8)b,d<0.001Depression0 (0)a,c516 (100)0 (0)a,c94 (24.4)<0.001Glucocorticoids1890 (86)451 (91.3)b,d400 (98)354 (93.2)b,d<0.001Cyclophosphamide or mycophenolate501 (23.5)145 (29.7)216 (54.3)139 (37.4)<0.001Antimalarials1869 (85.4)b,c433 (86.9)b,c317 (78.3)263 (71.1)<0.001SKI*, mean (SD)2.3 (1.4)2.8 (1.8)3.5 (1.8)a,d3.5 (2)a,d<0.001SDI**, mean (SD)0.7 (1)1.3 (1.8)1.6 (1.8)3.3 (2.5)<0.001Death46 (2.2)27 (5.6)45 (11.6)90 (25.2)<0.001Death by lupus14 (36.8)#8 (40)#8 (19.5)#24 (30.4)#0.27*Severity Katz Index; ** SLICC/ACR Damage Index. Regarding age, the p-value for the comparation between group 1 and 3 is 0.0498.#: no significant.a,b,c or dmeans the only significant comparison.AcknowledgementsResearch Unit of the Spanish Society of Rheumatology. Spanish Foundation of.Rheumatology financial supporting, through the research intensification grants program. GSK financial.supporting,Disclosure of InterestsNone Declared.