Risk of new-onset heart failure and heart failure exacerbations following COVID-19, influenza, or respiratory syncytial virus hospitalization

BACKGROUND: While acute respiratory-viral-infection (RVI) is associated with elevated short-term risk of concurrent cardiac events, less is known regarding subsequent heart-failure (HF) risk post-RVI hospitalisation. We evaluated risk of HF post-hospitalisation for influenza/COVID-19/respiratory-syncytial-virus(RSV). METHODS: Population-based retrospective cohort study, including all adult Singaporeans (≥18 years) hospitalised for influenza/COVID-19/RSV (01/01/2017-30/08/2023); stratified by pre-existing HF. Risks of acute HF (new-onset/readmission) post-RVI-hospitalisation was compared against controls (orthopaedic hospitalisations) using overlap-weighted competing-risks-regression. HF was ascertained using national healthcare-claims data. Analyses were further stratified by RVI type and vaccination status. RESULTS: Amongst individuals without pre-existing HF (N=59,408) hospitalised for RVI (influenza/COVID-19/RSV), overall risk of new-onset HF up to 180 days post-hospitalisation was elevated versus controls (adjusted-hazards-ratio, aHR=1.45[95%CI=1.26-1.67]). Risk of new-onset HF was observed up to 180 days post-hospitalisation for specific RVIs (RSV: aHR=2.03[95%CI=1.26-3.25]; COVID-19: aHR=1.36[95%CI=1.16-1.60]; influenza: aHR=1.62[95%CI=1.28-2.06]); however, risk was not significantly increased amongst influenza hospitalisations vaccinated <365 days prior (aHR=1.47[95%CI=0.82-2.64]). In HF patients (N=4163) hospitalised for RVI(influenza/COVID-19/RSV), risk of HF readmission was similarly increased (aHR=1.28[95%CI=1.08-1.52]). No increased risk of HF readmission post-COVID-19 was observed amongst individuals who received ≥4 COVID-19 vaccine doses (aHR=0.86[95%CI=0.59-1.27]), or who were vaccinated <180 days prior (aHR=0.97[95%CI=0.79-1.20]). Similarly, risk of HF readmission post-influenza was not significantly increased amongst individuals vaccinated <365 days prior (aHR=1.63[95%CI=0.94-2.82]). Elevated risk of HF readmission post-RVI hospitalisation predominantly accrued in older patients (≥70 years). CONCLUSIONS: RVIs can contribute to post-acute risk of new-onset HF and HF readmissions. Vaccination represents an opportunity for HF prevention amongst at-risk individuals.