Clinical InvestigationCongestive Heart FailureTumor necrosis factor-α antagonist use and heart failure in elderly patients with rheumatoid arthritis
Section snippets
Study patients and data sources
We conducted a retrospective cohort study pooling health care utilization databases from 2 states: (1) Medicare beneficiaries enrolled in the Pharmaceutical Assistance Contract for the Elderly in Pennsylvania from January 1, 1994, to December 31, 2004; and (2) Medicare beneficiaries enrolled in the Pharmaceutical Assistance to the Aged and Disabled or in Medicaid in the state of New Jersey from January 1, 1994, to December 31, 2004. Both drug benefit programs in Pennsylvania and New Jersey
Study patients and their characteristics
We identified 5,593 patients with RA who used TNFA and/or MTX. Of 1,002 TNFA users (704 [70%] with etanercept, 298 [30%] with infliximab), 565 (56%) had used MTX previously and 433 (43%) received MTX after TNFA initiation. The characteristics of the study population measured during the 2-year period before exposure to either a TNFA or MTX are shown in Table I. The characteristics of subjects who were originally identified as MTX users but later started on a TNFA were measured twice, once before
Discussion
We estimated the risk of HF hospitalization among users of TNFA versus MTX in an elderly RA population and found a 70% increase in the risk of HF hospitalization among users of TNFA compared with users of MTX, regardless of history of previous HF. We also found a 4.2-fold increase in the risk of death among patients with previous HF. As suggested by the new user analyses, our main results are likely to underestimate the true risk of TNFA on HF. The strengths of our study include the use of a
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