Risk of heart failure after spinal cord injury: a nationwide cohort study in South Korea

Retrospective cohort study.

To evaluate the long-term risk of heart failure (HF) following spinal cord injury (SCI) and to determine whether the risk differs by anatomical injury level.

Korean National Health Insurance and National Health Screening Program databases (2012-2023).

Newly diagnosed SCI cases from 2015 to 2023 were identified using ICD-10 codes after a 3-year washout period. Each patient with SCI was matched to 20 controls using propensity scores based on demographic, lifestyle, and metabolic variables. Incident HF was defined by at least two ICD-10 I50 records within one month. Incidence rate ratios (IRRs) and adjusted hazard ratios (aHRs) were estimated using stratified Cox models accounting for matched sets.

A total of 1412 patients with SCI (879 cervical; 572 thoracic/lumbar) and matched controls were included. Crude HF incidence rates per 1000 person-years were 10.25 for overall SCI and 10.76 for cervical SCI. IRRs were elevated for overall SCI (1.77; 95% CI, 1.36-2.29). In fully adjusted models, HF risk was increased for overall SCI (aHR 1.75; 95% CI, 1.13-2.71) and cervical SCI (aHR 2.12; 95% CI, 1.26-3.59), while thoracic/lumbar SCI showed a nonsignificant trend. Risks were highest among individuals aged ≥ 60 years and men with cervical SCI. Kaplan-Meier curves demonstrated lower HF-free survival across all SCI groups.

SCI was associated with an elevated long-term risk of HF, particularly among those with cervical injuries and older adults. These findings underscore the need for enhanced cardiovascular monitoring and early preventive strategies in high-risk SCI populations.