Infections requiring hospitalization linked to elevated heart failure risk
Key takeaways:
- Heart failure risk may be significantly elevated after infection-related hospitalization.
- HF risk was elevated for most infection subtypes, and applied to both HFpEF and HFrEF.
Infections requiring hospitalization were associated with increased risk for future incident heart failure, regardless of infection and HF subtype, according to new data published in the Journal of the American Heart Association.
The elevated HF risk after infection-related hospitalization ranged from 11% to nearly fourfold, based on the type of infection, researchers reported.
“There is growing evidence that severe infections might contribute to increased long-term risk for a variety of chronic diseases,” Ryan T. Demmer, PhD, MPH, FAHA, professor of epidemiology in the department of quantitative health sciences at Mayo Clinic College of Medicine and Science, told Healio. “However, there is limited research on the relationship between infections and the risk for heart failure.”
For the present analysis, the researchers evaluated data from 14,468 adults aged 45 to 64 years who participated in the ARIC study and were free from HF at baseline (mean age, 54 years; 55% women; 26% Black).
Infection-related hospitalization was identified using select ICD codes in hospital discharge records for respiratory, influenza, blood/circulatory, urinary tract, digestive tract, skin, hospital-acquired and other infections.
HF incidence was defined as first occurrence of a hospitalization with HF among primary or secondary diagnoses or a death certificate with HF among listed diagnoses or underlying causes of death.
During a median follow-up of 27 years, 46% of participants had an infection-related hospitalization and 25% had incident HF.
“We hypothesized that HF risk would be elevated following severe infections. The most surprising finding was how common severe infections were: Among a community-based sample of middle-aged adults, nearly half experienced a hospitalization with infection as a likely cause over approximately 25 years,” Demmer told Healio.
Compared with matched patients with no infection-related hospitalization, patients with at least one infection-related hospitalization had higher mean BMI (P = .001), systolic BP (P = .0004), prevalence of diabetes (P < .0001) and C-reactive protein levels (P < .0001).
In a fully adjusted model, any infection requiring hospitalization was associated with a more than twofold increased risk for subsequent HF (HR = 2.28; 95% CI, 2.1-2.47; P < .0001).
Risk for HF was elevated across most infection subtypes, from an approximately 34% increased risk among those with urinary tract infections requiring hospitalization (HR = 1.34; 95% CI, 1.04-1.72; P = .02) to near fourfold increased risk with blood/circulatory infections requiring hospitalization (HR = 3.83; 95% CI, 1.91-7.68; P = .0002), compared with no infection.
Similarly, risk for HF was also elevated after infection-related hospitalization, regardless of HF subtype (HR for HF with reduced ejection fraction = 1.77; 95% CI, 1.35-2.32; HR for HF with preserved EF = 2.97; 95% CI, 2.36-3.75).
“Additional research is necessary to better understand if the relationship is causal, and if so, whether interventions can mitigate HF risk among patients with a history of severe infections,” Demmer told Healio.
For more information:
Ryan T. Demmer, PhD, MPH, FAHA, can be reached at 200 First St. SW, Rochester, MN 55905.
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