Infection-Related Hospitalization and Incident Heart Failure in MarketScan: A Case-Crossover Study

BACKGROUND: Heart failure (HF) is a growing public health burden. Systemic inflammation is commonly observed in patients with HF and believed to be related to disease pathogenesis. Infection is a potential acute trigger of chronic inflammation. Our objective was to examine the relationship between infection-related hospitalization (IRH) and HF. METHODS AND RESULTS: We studied beneficiaries with at least 15 months of continuous enrollment in the US-based MarketScan databases during 2013 to 2019. We included n=152 008 patients with an inpatient or outpatient HF International Classification of Diseases, Ninth Revision/Tenth Revision (ICD-9/10) code in the primary position. Among patients with HF, IRH was identified using select ICD-9/10 codes. We used a case-crossover design to compare the frequency of IRH occurring within 3 months of the index HF event (case period) versus the frequency of IRH occurring 12 to 15 months before the index HF event (control period). Logistic models regressed the log-odds of having an IRH during the case versus control periods; odds ratios (ORs; 95% CIs) are presented. Among 152 008 beneficiaries, 53% were male with a mean±SD age of 56(±11) years. The odds of having an IRH during the case (versus control) period was elevated for both the 3-month case period (OR, 4.39 [95% CI, 4.18–4.60]), and 1-month case period (OR, 7.39 [95% CI, 6.88–7.94]), after adjusting for the total number of hospitalizations. This relationship persisted across different types of infections. CONCLUSIONS: IRH was associated with incident HF after both 1 and 3 months and may represent a modifiable risk factor for HF.