Infection in people with heart failure: an overlooked cause of adverse outcomes
Victoria Palin, Oliver Brown, Fergus Hamilton, Patrick Lillie, Mark Kearney, Richard M. Cubbon, Michael Drozd
Abstract
Infections are a major cause of morbidity and mortality in people with heart failure, accounting for approximately 25% of hospitalisations and deaths. Infection hospitalisations in people with heart failure last twice as long as other hospitalisations, with mortality rates after discharge being comparable to those seen after acute decompensated heart failure. Addressing this major challenge is essential to further improving the survival and quality of life of this population. However, very few studies have sought to understand why people with heart failure are predisposed to adverse infection outcomes and there are currently very few interventions that target this problem. In this review, we explore the underlying factors that may predispose individuals with heart failure to infection, highlight the impact of infections on outcomes, explore the potential strategies that may reduce adverse infection outcomes, and highlight future research priorities. • Infection is a leading cause of hospitalisation and death in people with heart failure. • Multimorbidity, frailty, chronic inflammation and suboptimal vaccine response may contribute to increased infection incidence and worse outcomes following an infection event. • Clinicians should maintain a high index of suspicion for infection, even in the absence of typical signs like tachycardia and pyrexia. • Management should prioritise infection prevention through vaccination, early detection and timely treatment. • Further research is needed to better understand the underlying mechanisms and to improve infection prevention and management strategies in populations with heart failure.