Newly Diagnosed Infection After Admission for Acute Heart Failure: From the KCHF Registry

Abstract

Background No studies have explored the association between newly diagnosed infections after admission and clinical outcomes in patients with acute heart failure. We aimed to explore the factors associated with newly diagnosed infection after admission for acute heart failure, and its association with in-hospital and post-discharge clinical outcomes. Methods and Results Among 4056 patients enrolled in the Kyoto Congestive Heart Failure registry, 2399 patients without any obvious infectious disease upon admission were analyzed. The major in-hospital and post-discharge outcome measures were all-cause deaths. There were 215 patients (9.0%) with newly diagnosed infections during hospitalization, and 2184 patients (91.0%) without infection during hospitalization. The factors independently associated with a newly diagnosed infection were age ≥80 years, acute coronary syndrome, non-ambulatory status, hyponatremia, anemia, intubation, and patients who were not on loop diuretics as outpatients. The newly diagnosed infection group was associated with a higher incidence of in-hospital mortality (16.3% and 3.2%, P<0.001) and excess adjusted risk of in-hospital mortality (odds ratio, 6.07 [95% CI, 3.61-10.19], P<0.001) compared with the non-infection group. The newly diagnosed infection group was also associated with a higher 1-year incidence of post-discharge mortality (19.3% in the newly diagnosed infection group and 13.6% in the non-infection group, P<0.001) and excess adjusted risk of post-discharge mortality (hazard ratio, 1.49 [95% CI, 1.08-2.07], P=0.02) compared with the non-infection group. Conclusions Elderly patients with multiple comorbidities were associated with the development of newly diagnosed infections after admission for acute heart failure. Newly diagnosed infections after admission were associated with higher in-hospital and post-discharge mortality in patients with acute heart failure. Registration URL: https://ichgcp.net/clinical-trials-registry/NCT02334891" title="See in ClinicalTrials.gov">NCT02334891.

Keywords: acute heart failure; heart failure; infections; mortality.

Figures

Figure 1. Kaplan–Meier curves for outcomes after discharge.

A, All‐cause death, (B) cardiovascular death, (C) non‐cardiovascular death, and (D) HF hospitalization. Main outcome measure was all‐cause death. Risk‐adjusting variables selected for the Cox proportional hazard model and Fine–Gray subdistribution hazard model: age ≥80 y, sex, body mass index ≤22 kg/m2, cause of HF hospitalization associated with ACS, previous HF hospitalization, hypertension, diabetes, atrial fibrillation or flutter, previous myocardial infarction, previous stroke, chronic lung disease, ambulatory status, systolic blood pressure <90 mm Hg, heart rate <60 beats/min, LVEF <40% on echocardiography, eGFR <30 mL/min per 1.73 m2, serum albumin <30 g/L, serum sodium <135 mEq/L, anemia, prescription of ACEIs or ARBs at discharge, and prescription of β‐blockers at discharge. ACEIs indicates angiotensin‐converting enzyme inhibitors; ACS, acute coronary syndrome; ARBs, angiotensin II receptor blockers; eGFR, estimated glomerular filtration rate; HF, heart failure; HR, hazard ratio; LVEF, left ventricular ejection fraction; and N, number.