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Systemic Sclerosis and Related Diseases · Journal article
Journal of the American Heart Association · July 28, 2026
A consensus or society position rather than new primary data.
This is a narrative review examining the intersection of systemic rheumatologic disease and HFpEF, identifying shared pathophysiological mechanisms (chronic inflammation, microvascular dysfunction, myocardial fibrosis) and diagnostic-therapeutic gaps. The work highlights that patients with rheumatologic diseases exhibit markedly increased HFpEF risk but remain underrepresented in trials and underexplored as a target for anti-inflammatory therapies.
Narrative review. Patients with systemic rheumatologic diseases (rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, systemic sclerosis) and concurrent HFpEF.
HFpEF represents over half of all heart failure cases and is increasingly recognized in individuals with systemic rheumatologic diseases Patients with rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and systemic sclerosis exhibit markedly increased risk of HFpEF Chronic inflammation, microvascular dysfunction, and myocardial fibrosis emerge as key pathophysiological drivers in this population
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Clinicians should recognize HFpEF as a distinct inflammatory phenotype in rheumatologic disease populations, acknowledge diagnostic complexity from atypical symptoms and overlapping comorbidities, and recognize that current HFpEF management does not target immune mechanisms. Collaborative cardiology-rheumatology approaches and inclusive trial design are needed to optimize outcomes.
A narrative review synthesizing pathophysiological mechanisms linking rheumatologic disease to HFpEF, identifying diagnostic and therapeutic gaps without reporting new primary evidence or quantitative outcomes.
As stated by the source record.
Clinicians should recognize HFpEF as a distinct inflammatory phenotype in rheumatologic disease populations, acknowledge diagnostic complexity from atypical symptoms and overlapping comorbidities, and recognize that current HFpEF management does not target immune mechanisms. Collaborative cardiology-rheumatology approaches and inclusive trial design are needed to optimize outcomes.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Systemic inflammation has gained attention in heart failure (HF), particularly HF with preserved ejection fraction (HFpEF); a heterogeneous syndrome representing over half of HF cases and increasingly recognized in individuals with systemic rheumatologic diseases. Although myocardial infarction and HF with reduced EF have traditionally been emphasized in the context of systemic inflammation, recent data suggest that HFpEF is the predominant phenotype, often arising independently of overt coronary artery disease. Despite substantial cardiovascular morbidity and mortality, patients with rheumatologic disease remain underrepresented in HF research, and the mechanisms linking inflammation to HFpEF remain underdescribed in this population. This review examines the intersection of systemic rheumatologic disease and HFpEF, focusing on shared pathophysiology, diagnostic challenges, and therapeutic opportunities. Patients with rheumatologic diseases, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and systemic sclerosis, exhibit a markedly increased risk of HFpEF. Chronic inflammation, microvascular dysfunction, and myocardial fibrosis emerge as key drivers. These conditions complicate diagnosis because of atypical symptoms and overlapping comorbidities. Although existing HFpEF therapies primarily target hemodynamic and metabolic contributors, they seldom address immune-mediated mechanisms. Anti-inflammatory strategies have shown cardiovascular benefit in selected populations; yet their role in HFpEF among rheumatologic subgroups remains underexplored. Exclusion of patients with rheumatologic disease or immunosuppressive therapy from HFpEF trials further limits generalizability. In conclusion, HFpEF associated with rheumatologic disease represents a distinct, underrecognized inflammatory phenotype. Collaborative cardiology-rheumatology research is needed to refine diagnosis, evaluate immunomodulatory strategies, and design inclusive clinical trials to improve outcomes in this growing population.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.