Hospitalizations with Initiation of Hydroxychloroquine in Patients with Heart Failure with Preserved Ejection Fraction and Autoimmune Disease

OBJECTIVES: Hydroxychloroquine (HCQ) is commonly used for the management of several autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome. Previously, some observational studies have reported that HCQ is associated with increased risk of cardiovascular disease. We aimed to assess association of HCQ initiation with HF-related and all-cause hospitalizations among patients with heart failure and preserved ejection fraction (HFpEF).

METHODS:

We conducted a cohort study of patients aged >18 years with diagnosed HFpEF and autoimmune disease using MarketScan® Commercial and Medicare Supplemental databases (2007–2019). Patients were required to initiate HCQ after their first HFpEF diagnosis (HCQ users) or not (HCQ non-users). For the patients in the HCQ users group, the first HCQ prescription date was assigned as the index date. Index date for the HCQ non-user group was assigned by a prescription-time distribution matching HCQ users, utilizing the number of days from HFpEF diagnosis to the first HCQ prescription. After 1 up to 3 propensity score matching, Cox proportional hazards regression models were used to compare HF-related and all-cause hospitalizations between the HCQ users and non-users.

RESULTS: After propensity score matching, 2,229 patients (592 HCQ users and 1,637 HCQ non-users) were included. The crude incidence rates of HF-related hospitalization were 0.32 and 0.77 per 100 person-months for HCQ users and non-users, respectively. The crude incidence rates of all-cause hospitalization were 4.30 and 7.47 per 100 person-months for HCQ users and non-users, respectively. After controlling for covariates, HCQ users had lower risk of HF-related hospitalization (adjusted hazard ratio [aHR], 0.44; 95% confidence interval [CI], 0.24-0.82) and all-cause hospitalization (aHR, 0.69; 95% CI, 0.57-0.83) as compared to non-user group.

CONCLUSIONS: Among patients with HFpEF and autoimmune disease, HCQ use was associated with decreased risk of HF-related and all-cause hospitalizations