Association Between End-Stage Liver Disease and Incident Heart Failure in an Integrated Health System

Background: End-stage liver disease (ESLD) and heart failure (HF) often coexist and are associated with significant morbidity and mortality. However, the true incidence of HF among patients with ESLD remains understudied. Objective: This study aims to evaluate the association between ESLD and incident HF in a real-world clinical cohort. Design and Participants: A retrospective electronic health records database analysis of individuals with ESLD and frequency-matched controls without ESLD in a large integrated health system. Main Measures: The primary outcome was incident HF, which was defined by the International Classification of Disease codes and manually adjudicated by physician reviewers. The Kaplan–Meier method was used to estimate the cumulative incidence of HF. Multivariate proportional hazards models adjusted for shared metabolic factors (diabetes, hypertension, chronic kidney disease, coronary heart disease, body mass index) were used to compare the risk of HF in patients with and without ESLD. Key Results: Of 5004 patients (2502 with ESLD and 2502 without ESLD), the median (Q1–Q3) age was 57.0 (55.0–65.0) years, 59% were male, and 18% had diabetes. Over a median (Q1–Q3) follow-up of 2.3 (0.6–6.0) years, 121 incident HF cases occurred. Risk for incident HF was significantly higher for patients with ESLD compared with the non-ESLD group (adjusted HR: 4.67; 95% CI: 2.82–7.75; p < 0.001), with the majority of the ESLD group (70.7%) having HF with preserved ejection fraction (ejection fraction ≥ 50%). Conclusion: ESLD was significantly associated with a higher risk of incident HF, independent of shared metabolic risk factors, with the predominant phenotype being HF with preserved ejection fraction.