Issue 12

Clinical Question

Does IBD increase the risk for heart failure?

Editor’s Bottom Line

IBD patients experiencing flares or poorly managed symptoms have a 2.5-fold increased risk of hospitalization for heart failure than non-IBD individuals.

Editorial Note

• This study supports the increase in cardiac events with active inflammation that has been previously described.
• The study used medication and hospital admissions to indicate IBD activity instead of clinical or inflammatory markers. This may have biased the results to flare-specific treatments, such as steroids.

Reference

Kristensen SL, Ahlehoff O, Lindhardsen J, et al. Inflammatory bowel disease is associated with an increased risk of hospitalization for heart failure: a Danish Nationwide Cohort study. Circ Heart Fail. 2014 Sep;7(5):717–22.
https://www.ncbi.nlm.nih.gov/pubmed/25052190

Synopsis

In this nationwide study, 5,436,647 Danes with neither heart failure nor IBD were included in the cohort beginning January 1, 1997. Databases used were the Civil Person Registration and National Patient Register, and Danish Register of Medicinal Product Statistics. Each person was followed until the first hospitalization for heart failure, death, or December 31, 2011. During the study, 23,681 were diagnosed with IBD (CD: 26.7%) and compared against the non-IBD reference population. Baseline characteristics were similar between the two groups regarding age, gender ratios, medication and comorbidities pertaining to non-IBD related conditions or diseases.

The average follow-up was 11.8 years and 6.4 years in the reference and IBD populations. Persons with IBD had a 37% increased risk of hospitalization for heart failure compared to the reference population. Importantly, the increased risk of heart failure hospitalization for patients with IBD was only associated with IBD flares (incident rate ratio [IRR] 2.54) and persistent IBD symptoms (IRR 2.73). During remission, patients with IBD had a marginal increased risk of heart failure hospitalization (IRR 1.04).

Details

Study Design: Retrospective nationwide cohort study
Funding: P. Carl Petersens Foundation, Novo Nordisk Foundation
Allocation: IBD diagnosis
Setting: Denmark
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.