Severe infections linked to increased risk of heart failure

Findings highlight the importance of infection prevention measures and personalized heart failure care.

A study funded by the National Institutes of Health has found that adults who were hospitalized for a severe infection, such as respiratory infections or sepsis, were more than twice as likely to develop heart failure years later. The findings, published in the Journal of the American Heart Association, underscore the importance of measures that help prevent severe infections, such as getting up-to-date vaccines and practicing safe hygiene.

These are 'sit-up and take notice' findings. While there's already a reasonable body of evidence linking previous infections with heart attack, this study is focused on heart failure, which has been less studied yet affects an estimated six million Americans."

Sean Coady, M.A., deputy branch chief in the Division of Cardiovascular Sciences at the NIH's National Heart, Lung, and Blood Institute

The study, part of the NHLBI-funded Atherosclerosis Risk in Communities (ARIC) Study, followed 14,468 adults aged 45-64 for up to 31 years, from 1987 to 2018. None had heart failure when the study began. The researchers found that individuals who experienced an infection-related hospitalization had a 2.35 times higher risk of developing heart failure at an average time of seven years after surviving the hospitalization, compared to those who did not get an infection. The researchers adjusted for sociodemographic and health-related factors and included different infection types, such as respiratory, urinary tract infections, and hospital-acquired in their assessment. They found that the association with heart failure was consistent no matter the type of infection.

Heart failure occurs when the heart is unable to pump enough blood to the body's organs and tissues. While there are many different kinds, the study focused mainly on heart failure with preserved ejection fraction (HFpEF), which occurs when the left side of the heart is too stiff to fully relax between heartbeats, and heart failure with reduced ejection fraction (HFrEF), which occurs when the left ventricle is too weak to pump out enough blood to the body. The researchers discovered that infections that required hospitalization were associated with an increased risk of both conditions. Notably, the risk was nearly three times higher for HFpEF, the most common form of heart failure among people over age 65 and the one with the most limited treatment options. Nearly half of participants experienced an infection-related hospitalization emphasizing the potentially large impact of severe infections on the heart health of older adults.

While the study only found an association between severe infections and heart failure - not a causal link - Ryan Demmer, Ph.D. professor of epidemiology at the Mayo Clinic in Rochester, Minn. and the study's senior author, said patients still should consider commonsense approaches that keep severe infections at bay. He explained that someone who experiences an infection and are at high risk for cardiovascular disease should speak with their primary care provider to be sure they are receiving guideline directed medical therapies for cardiovascular disease.

Demmer said future research could build on the current findings by validating a causal link between infections and heart failure development. New research could also explore the potential for incorporating infection history into heart failure risk assessments and patient management strategies.