Objectives: To investigate the risk of incident ischaemic and non-ischaemic heart failure (HF) in a population-based cohort of all patients with SSc in Sweden compared with the general population.
Methods: We identified patients with incident SSc 2004-19 using nationwide Swedish registers and age- and sex-matched comparators from the general population (1:10). We started follow-up from the date of SSc diagnosis, the same date was assigned to the respective comparators. Our primary outcome was incident HF [International Statistical Classification of Diseases and Related Health Problems (ICD)-10: I50] as main diagnosis stratified into ischaemic and non-ischaemic HF depending on whether a visit listing ischaemic heart disease (ICD-10: I20-I25) was recorded before HF diagnosis or not. We used flexible parametric models to estimate hazard ratios (HRs) over time since SSc diagnosis.
Results: The study cohort comprised 1598 patients with SSc and 16 616 comparators. During follow-up, 101 (6%) patients with SSc developed HF compared with 378 (2%) of the comparators. Ischaemic HF represented 35% and non-ischaemic HF represented 65% of all HF cases in both groups. The relative risk of HF overall, ischaemic HF and non-ischaemic HF was highest soon after SSc diagnosis. HR at the end of the first year of follow-up was 5.7 (95% CI 4.2-7.9) for HF overall, 6.7 (95% CI 3.5-13.0) for ischaemic HF and 5.8 (95% CI 4.0-8.3) for non-ischaemic HF.
Conclusion: SSc is associated with both ischaemic and non-ischaemic HF, emphasizing the role of other mechanisms than ischaemia, such as myocyte dysfunction, myocardial fibrosis and microvascular impairment, in the development of HF in SSc.
Keywords: heart failure; ischaemic heart disease; systemic sclerosis.
© The Author(s) 2025. Published by Oxford University Press on behalf of the British Society for Rheumatology.