Association between infection and mortality in acute heart failure in the emergency department: a cohort study

Acute heart failure (AHF) is a frequent cause of emergency department (ED) admissions, yet the prognostic impact of infection as a trigger remains insufficiently characterized.

To evaluate the impact of infection as a trigger of AHF on in-hospital mortality and postdischarge survival.

Retrospective observational cohort study.

All adult patients presenting with AHF to the ED of Strasbourg University Hospital in 2020 were included. Clinical and outcome data were collected from 1296 ED visits.

Infection and other AHF triggers were defined through adjudication based on clinical, imaging, and microbiological data collected throughout the hospital stay.

The primary outcome was in-hospital mortality. Analyses were performed using inverse probability weighting (IPW). Postdischarge survival was assessed using IPW-weighted Kaplan-Meier estimates and Cox models.

Infection was identified in 119 ED visits [9.2%, 95% confidence interval (CI): 7.7-10.9]. Patients with infection had higher in-hospital mortality than those without infection (30.3% vs. 9.0%, P  < 0.001). In IPW-weighted analyses, infection was independently associated with in-hospital mortality [odds ratio (OR) = 2.76, 95% CI: 1.64-4.66]. In contrast, atrial fibrillation (OR = 0.45, 95% CI: 0.23-0.87) and acute coronary syndrome (OR = 0.08, 95% CI 0.01-0.58) were associated with lower in-hospital mortality. Infection was also associated with reduced postdischarge survival (hazard ratio = 1.64, 95% CI: 1.14-2.37, P  = 0.008).

Infection is a strong and independent predictor of short- and long-term mortality in patients presenting with AHF in the ED.