Predictors of infection-related rehospitalization in heart failure patients and its impact on long-term survival

BACKGROUND: Infection is the most common non-cardiovascular cause of re-hospitalizations for heart failure patients. We therefore investigated the predictors of infection-related re-hospitalization (IRRH) in heart failure patients and its impact on long-term survival. METHODS AND RESULTS: We prospectively recruited 622 patients after the index hospitalization for decompensated heart fail with primary endpoints of IRRH and all-cause mortality. During follow-up of 3.9 ± 2.7 years, IRRHs occurred in 104 (16.7%) patients. Of the 104 patients who experienced IRRHs, the time from the index hospitalization to IRRH was 1.0 (interquartile range: 0.4–2.6) years. Independent predictors of IRRH were age (hazard ratio: 1.02, 95% confidence interval: 1.01–1.04), diabetes mellitus (2.12, 1.42–3.17), not taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (1.67, 1.01–2.78), needing maintenance therapy with a loop diuretic (2.10, 1.36–3.26), hemoglobin levels (0.87, 0.79–0.96), and estimated glomerular filtration rates (eGFRs) (0.99, 0.98–0.99). IRRH independently predicted all-cause mortality (1.99, 1.32–2.98) after adjusting for age, body mass index, New York Heart Association functional class, chronic obstructive pulmonary disease, brain natriuretic peptide, hemoglobin, and eGFR. The increased risk of death associated with IRRHs was predominantly for lower respiratory tract infections (3.71, 2.28–6.04), urogenital tract infections (2.83, 1.32–6.10), and sepsis (3.26, 1.20–8.85). CONCLUSION: IRRHs in patients discharged for acute decompensated heart fail independently predicted worse long-term survival. We further identified independent predictors of IRRHs. These findings warrant future studies for tackling IRRH.