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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.