Frequency and Impact of Infectious Disease Conditions Diagnosed During Decompensated Heart Failure Hospitalizations in the United States

There are limited data on the frequency of diagnosis of infectious disease and its impact on patients hospitalized with decompensated heart failure. We sought to evaluate the preva-lence, types, trends, and outcomes of infectious disease diagnosis in patients admitted with decompensated heart failure. We performed a retrospective cohort study in patients admitted with a primary diagnosis of heart failure using the National Inpatient Sample database from 2009 to 2019. Patients with a length of stay >= 3 days were included. Patients with chronic dialysis, left ventricular assist devices, cardiogenic shock, or solid organ transplantation or who required mechanical ventilation or mechanical circulatory support were excluded. Patients were stratified according to the presence or absence of infectious disease diagnosis. Outcomes of interest were in-hospital mortality, length of stay, and resource utilization. Among the 7,228,521 admissions with a primary diagnosis of heart failure that met the inclusion and exclusion criteria, an infectious disease diagnosis was reported in 1,806,514 (24.9%). Infectious disease diagnosis was more frequent in patients who were female, older, and White, and who had higher baseline co-morbidity. Since 2014, there has been a steady decrease in infectious conditions in patients admitted with a primary diagnosis of heart failure (p for trend <0.01). After propensity match analysis was performed, patients with infectious disease diagnosis had a longer length of stay (6.9 vs 5.7 days, p <0.001) and higher cost ($14,305 vs $11,760, p <0.001), were less likely to be discharged home (35.3% vs 44.7%, p <0.001), and had higher in-hospital mortality (2.6% vs 1.6%, p <0.001). In conclusion, approximately 1 in 4 patients admitted with pri-mary heart failure will be diagnosed with an infectious condition. The presence of an infec-tious disease diagnosis is associated with increased morbidity and mortality. (c) 2022 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;191:1-7)

Automated summary

This study aimed to assess the prevalence, types, trends, and outcomes of infectious disease diagnosis in patients with decompensated heart failure. It found that 24.9% of heart failure patients had an infectious disease diagnosis, which was associated with longer length of stay, higher cost, lower discharge rate, and higher in-hospital mortality.