Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease associated with an increased risk of cardiovascular complications, including heart failure (HF). HF represents a major cause of morbidity and mortality among patients with RA, contributing substantially to their reduced life expectancy. The early detection and optimal management of both traditional cardiovascular risk factors and RA-related inflammation are crucial to improving outcomes. In this comprehensive narrative review, we synthesize and critically appraise contemporary evidence on the epidemiology, pathophysiology, diagnosis, and management of HF in RA. We further explore emerging insights into the inflammatory and immune-mediated mechanisms driving myocardial dysfunction, advances in the early and preclinical detection of HF through novel imaging and biomarker approaches, and the evolving impact of modern RA therapies on cardiovascular health with a focus on heart failure. These developments highlight the importance of integrated, multidisciplinary strategies to prevent and manage heart failure in patients with rheumatoid arthritis.

Background and Objectives: Rheumatic diseases confer excess cardiovascular risk, yet prognosis after acute coronary syndrome (ACS) in contemporary angiography-treated care remains incompletely characterized, particularly when psychiatric multimorbidity is considered. We evaluated whether documented rheumatic disease was associated with psychiatric comorbidity and post-discharge mortality after ACS. Materials and Methods: We retrospectively analyzed a predefined two-center registry extract of 2950 consecutive patients who underwent coronary angiography for ACS. Documented rheumatic disease was identified from diagnoses recorded in admission history, prior medical records, or discharge documentation and was not re-adjudicated. The primary outcome was post-discharge all-cause mortality. Results: Documented rheumatic disease was present in 106 patients (3.6%). Compared with patients without documented rheumatic disease, exposed patients were older, more often women, more often hypertensive, and more likely to have a documented psychiatric disorder (25.5% vs. 14.1%). Short-term mortality was similar, whereas crude overall long-term mortality was higher (27.4% vs. 19.3%). Among hospital survivors with usable follow-up, post-discharge survival was worse (log-rank p = 0.013). Documented rheumatic disease was associated with higher post-discharge mortality in unadjusted analysis (hazard ratio 1.66, 95% confidence interval 1.11–2.48) and in a prespecified parsimonious model (adjusted hazard ratio 1.56, 95% confidence interval 1.04–2.34); the association attenuated and was no longer statistically significant in a broader exploratory model (adjusted hazard ratio 1.35, 95% confidence interval 0.87–2.07). Documented psychiatric disorder independently predicted mortality. Conclusions: In angiography-treated ACS, documented rheumatic disease was associated with greater psychiatric comorbidity and worse post-discharge survival in a small, documentation-defined, heterogeneous subgroup. Because the signal attenuated in broader exploratory adjustment and exposure ascertainment was documentation-based, the findings should be regarded as hypothesis-generating rather than disease-specific or causal.