Severe infections (infection-related hospitalization) were associated with incident heart failure and may serve as a risk-enhancing factor warranting enhanced preventive measures, particularly in populations where IRH is more common.
Key Findings
Results
Infection-related hospitalization (IRH) was associated with significantly higher rates of incident heart failure compared to matched comparators.
Among the IRH group, 2729 developed incident HF at a rate of 2.75 per 100 person-years.
In the comparator group (no IRH), 4854 developed incident HF at a rate of 1.00 per 100 person-years.
Median follow-up time was 6.2 years.
The study population included 80,880 adults (14,150 with IRH and 66,730 age- and sex-matched comparators) aged ≥18 years without HF at baseline.
Results
After multivariable adjustment, IRH was associated with an 85% higher hazard of incident heart failure.
Multivariable adjusted hazard ratio for incident HF among participants with versus without IRH was 1.85 (95% CI, 1.76–1.94).
IRH was identified using International Classification of Diseases (ICD) codes.
HF incidence was defined as ≥1 HF-related ICD code.
Participants were drawn from the Rochester Epidemiology Project, 1/1/2005–12/31/2019.
Results
Incorporating IRH into the PREVENT-HF risk equation produced a statistically significant but negligible improvement in overall heart failure risk discrimination.
Adding IRH to PREVENT-HF increased Harrell's concordance statistic from 0.776 to 0.779, a change of 0.003 (95% CI, 0.001–0.004).
This analysis was conducted in a separate subcohort of 29,219 adults aged 30–79 years without baseline cardiovascular disease.
The authors characterized this change as 'negligible' in terms of overall population-level discrimination.
PREVENT-HF stands for Predicting Risk of Cardiovascular Disease EVENTs-Heart Failure.
Results
The PREVENT-HF risk score systematically underestimated 10-year heart failure risk among individuals who had experienced an IRH.
PREVENT-HF underestimated the 10-year risk of HF by up to 9% among participants with an IRH.
This finding indicates that standard risk equations may inadequately capture HF risk in the subgroup with prior severe infection.
The authors noted that incorporating IRH information 'meaningfully improved 10-year HF risk prediction' among individuals with an IRH.
Methods
The study population was predominantly female, White, and non-Hispanic, with a mean age in the mid-50s.
Participants were 53.3% women, 85.6% White individuals, and 95.1% non-Hispanic individuals.
Mean age was 56.0 ± 20.0 years.
The cohort was drawn from the Rochester Epidemiology Project, a large clinical health system-based registry.
The study period spanned January 1, 2005 to December 31, 2019.
Conclusions
The authors propose that severe infections may serve as a novel risk-enhancing factor for heart failure, particularly relevant to populations where IRH is more common.
The authors suggest IRH warrants 'enhanced preventive measures, particularly in populations where IRH is more common.'
The framing as a 'risk-enhancing factor' parallels how other non-traditional risk factors are used in cardiovascular prevention guidelines.
The authors note that while IRH adds negligible discrimination at the population level, it is meaningful at the individual level for those with a prior severe infection.
What This Means
This research suggests that being hospitalized for a severe infection is linked to a substantially higher risk of developing heart failure later in life. Studying nearly 81,000 adults from a large health system over an average of more than six years, researchers found that people who had been hospitalized for an infection developed heart failure at nearly three times the rate of similar people who had not been hospitalized for infection. Even after accounting for other known risk factors, people with a prior severe infection were about 85% more likely to develop heart failure.
The study also tested whether adding severe infection history to an existing heart failure prediction tool (called PREVENT-HF) improved its accuracy. At the population level, the improvement was real but very small. However, for individuals who had already experienced a severe infection, the standard prediction tool significantly underestimated their true risk — by as much as 9% over 10 years — and accounting for their infection history meaningfully corrected this gap.
This research suggests that a history of severe infection (the kind requiring hospitalization) could be used as a 'risk-enhancing factor' — similar to how doctors already use certain other non-traditional risk factors — to flag individuals who may need more aggressive heart failure prevention strategies. This could be especially important in communities or populations where severe infections are more common, and points to a potential connection between the body's response to serious infections and the development of heart disease.
Demmer R, Grossardt B, Khan S, Borlaug B. (2026). Severe Infections as a Novel Risk-Enhancing Factor for Incident Heart Failure.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047537