Severe Infections as a Novel Risk-Enhancing Factor for Incident Heart Failure

We examined the relationship between infection-related hospitalization (IRH) and heart failure (HF) in a large clinical health system and assessed whether IRH improved prediction beyond HF risk equations.

We studied 80 880 adults (14 150 with IRH and 66 730 age- and sex-matched comparators) aged ≥18 years without HF in the Rochester Epidemiology Project from 1/1/2005-12/31/2019. IRH was identified using International Classification of Diseases (ICD) codes. HF incidence was defined as ≥1 HF-related ICD code. Multivariable Cox models assessed the association between IRH and incident HF. Among 29 219 adults aged 30 to 79 years without baseline cardiovascular disease in the Rochester Epidemiology Project, Harrell's concordance statistic assessed whether IRH improved discrimination of the Predicting Risk of Cardiovascular Disease EVENTs-Heart Failure (PREVENT-HF) equations.

Participants were 53.3% women, 85.6% White individuals, and 95.1% non-Hispanic individuals, with a mean age of 56.0±20.0 years. Median follow-up time was 6.2 years. Among the IRH group, 2729 developed incident HF (2.75/100 person-years) versus 4854 (1.00/100 person-years) in the comparator. The multivariable adjusted hazard ratio for incident HF among participants with versus without an IRH was 1.85 (95% CI, 1.76, 1.94). In a separate cohort, incorporating IRH into PREVENT-HF increased the concordance statistic from 0.776 to 0.779 (change, 0.003 [95% CI, 0.001-0.004]). The PREVENT-HF risk score underestimated the 10-year risk of HF by up to 9% among participants with an IRH.

IRH was associated with incident HF but provided negligible change to 10-year HF risk discrimination. However, among individuals with an IRH, incorporating this information meaningfully improved 10-year HF risk prediction. Severe infections may serve as a risk-enhancing factor warranting enhanced preventive measures, particularly in populations where IRH is more common.