Consensus best practice pathway of the UK Systemic Sclerosis Study group: management of cardiac disease in systemic sclerosis

• Published in: Rheumatology (Oxford, England) England), 2017-06, Vol.56 (6), p.912-921
• Main Authors: Bissell, Lesley-Anne, Anderson, Marina, Burgess, Malcolm, Chakravarty, Kuntal, Coghlan, Gerry, Dumitru, Raluca B, Graham, Lee, Ong, Voon, Pauling, John D, Plein, Sven, Schlosshan, Dominik, Woolfson, Peter, Buch, Maya H
• Format: Article
• Language: English
• Subjects: Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - therapy; Biomarkers - blood; Cardiomyopathies - chemically induced; Cardiomyopathies - diagnosis; Cardiomyopathies - therapy; Cardiovascular Agents - adverse effects; Electrocardiography; Evidence-Based Medicine; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - therapy; Humans; Magnetic Resonance Angiography; Medical History Taking - methods; Monitoring, Ambulatory - methods; Patient Care Team - organization & administration; Pericarditis - diagnosis; Pericarditis - etiology; Pericarditis - therapy; Physical Examination - methods; Risk Factors; Scleroderma, Systemic - diagnosis; Scleroderma, Systemic - therapy
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kew488

Cardiac disease in SSc can manifest in various ways and is associated with a poor prognosis. There is little evidence on how best to detect and manage cardiac disease in SSc. Our objective was to produce an expert consensus best practice pathway for the management of cardiac disease in SSc. The UK Systemic Sclerosis Study Group set up several working groups to develop a number of consensus best practice pathways for the management of SSc-specific complications, including cardiac disease. A multidisciplinary task force was convened. The guidelines were partly informed by a comprehensive literature review. A best practice pathway for cardiac disease (with a focus on primary cardiac disease) in SSc is presented, including approaches for early detection and standard pharmacological and device therapies. Due to the benefits, shared care and a multidisciplinary approach are recommended. A future research agenda has been formulated in response to the relative lack of understanding of the natural history of primary cardiac disease that was highlighted by the initiative. The physician should be alert to the possibility of cardiac disease in SSc; it is best managed within a multidisciplinary team including both rheumatologists and cardiologists. This pathway provides a reference for all physicians managing patients with SSc.