Cardiologists Urge Inflammation-Focused Care for Patients With Acute Heart Failure

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Patients with inflammatory disorders and acute heart failure experienced more cardiovascular complications despite similar in-hospital mortality.

Acute heart failure (HF) is a major driver of hospital admissions and a leading cause of cardiovascular mortality in the United States. Although chronic inflammatory disorders (IDs) are known to increase cardiovascular risk, their impact on acute HF outcomes has not been well defined.

A new nationwide study presented at ACC.25 by Alon Roguin, MD, and colleagues sheds light on this question. Using data from the National Inpatient Sample between 2016 and 2019, researchers analyzed 1,042,218 AHF-related admissions. Among those, 39,485 patients had an accompanying inflammatory condition such as rheumatoid arthritis (RA), psoriasis, systemic lupus erythematosus (SLE), Crohn’s disease (CD), ulcerative colitis (UC), systemic scleroderma (SSc), Sjögren’s syndrome, or mixed connective tissue disease (MCTD).

Patients with IDs were slightly older (72 vs 71 years) and more likely to be women (67.8% vs 47.0%). In-hospital mortality was similar between groups. However, those with IDs had significantly higher rates of major adverse cardiovascular and cerebrovascular events (MACCE), as well as longer hospital stays (5.63 vs 5.36 days).

Subgroup analysis revealed further differences: patients with SLE, CD, SSc, and MCTD had increased odds of in-hospital death, while those with UC and Sjögren’s syndrome had lower odds, suggesting that inflammation may not raise short-term mortality overall but does contribute to complications that can affect long-term outcomes and quality of care.

Expert Perspectives on Inflammation & Cardiovascular Risk

“The short answer is yes, inflammatory conditions do increase the risk for cardiovascular problems,” says cardiologist George P. Rodgers, MD. “We’ve known for some time that patients with RA or SLE are more likely to experience coronary artery disease and heart attacks. The inflammation appears to damage the arterial lining, contributing to atherosclerosis.”

Dr. Rodgers also emphasizes that the scope of inflammatory risk extends beyond autoimmune diseases.

“Obesity itself is an inflammatory condition,” he says. “It raises systemic inflammation, which contributes to cardiac problems. That’s one reason why many of us support the use of GLP-1 medications. They help reduce inflammation and support weight loss, which can be very beneficial for heart health.”

Both Dr. Rodgers and Natalia Beridze, MD, agree that an individual’s inflammatory status should influence their cardiovascular screening and management.

“When your patient has an inflammatory condition, managing that inflammation becomes a key part of cardiac care,” Dr. Rodgers says. “Whether it’s helping the patient lose weight or treating conditions like RA or SLE, the goal is to reduce systemic inflammation to lower cardiovascular risk.”

Dr. Beridze adds, “Systemic inflammation accelerates arterial damage and atherosclerosis. This can lead to coronary artery disease, cerebrovascular disease, and cardiomyopathies. That’s why we screen patients with inflammatory diseases earlier and more aggressively.”

Implications for Patient Management

Dr. Beridze says the study’s findings have the potential to change clinical approaches.

“SLE, Crohn’s, scleroderma, and MCTD were associated with higher mortality in this study. That means we may need to lower the threshold for cardiac workups in patients with those conditions,” she said. “On the other hand, Sjögren’s and UC may not carry the same risk, which is helpful when tailoring care.”

Although inflammatory disorders increased the rate of adverse events, they did not appear to raise in-hospital mortality. Dr. Rodgers believes this is due to standardized care protocols once patients are admitted.

“Once a patient is hospitalized with an acute cardiac event, our treatment approach is the same whether or not they have an inflammatory condition,” he explains. “That may explain why we don’t see a difference in mortality. But we do see more secondary events like strokes or additional cardiac issues in these patients.”

Both cardiologists emphasized the growing recognition of inflammation as a core cardiovascular risk factor.

“We are recognizing inflammation, including that from obesity, as a major contributor to heart disease,” Dr. Rodgers says. “This study adds weight to that idea and reinforces the importance of addressing inflammation early and thoroughly.”