ArticleBMC medicine2026
Temporal associations between severe infection and long-term risk of incident arrhythmias: a population-based cohort study.
Article in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe long-term impact of severe infection on arrhythmia risk across the cardiac rhythm spectrum remains incompletely characterized. We investigated the association between hospital-treated infection and incident arrhythmias, examining temporal patterns, pathogen and site specificity, and cumulative effects.
methodsWe conducted a prospective analysis of 465,374 UK Biobank participants. Time-dependent Cox proportional hazards models were adjusted for sociodemographic factors, lifestyle behaviors, clinical comorbidities, and biochemical parameters. Comprehensive analyses assessed infection timing (1-30, 31-365, ≥366 days), type (bacterial, viral, sepsis), site, and recurrence. Findings were validated in ARIC and CHS cohorts.
resultsOver a median follow-up of 14.2 years, 70,527 (15.2%) participants had a severe infection. Infection was associated with a significantly increased risk of any incident arrhythmia (adjusted HR 1.85, 95% CI 1.80-1.90). Risks were elevated across all specific arrhythmias, being particularly pronounced for sudden cardiac arrest (HR 2.79, 2.54-3.07), ventricular arrhythmias (HR 3.11, 2.80-3.45), and AV block (HR 3.03, 2.83-3.25). Risk demonstrated temporal gradient, peaking at 1-30 days (HR 11.40, 10.44-12.47 for any arrhythmia) and remaining elevated long-term (HR 1.58, 1.53-1.63 at ≥366 days). Sepsis posed the highest risk among infection types, while pneumonia was most hazardous among sites. Recurrent infections showed a dose-response relationship, with second infections conferring greater risk than first infections (HR 2.51 vs 1.85). Population attributable fractions for infection reached 16.6% for AV block, comparable to traditional risk factors. External validation confirmed these associations.
conclusionSevere infection is associated with increased long-term risks of various arrhythmias, with variations by time since infection, infection characteristics, and recurrence history. These observations suggest that a history of severe infection may provide modest additional information for arrhythmia risk assessment, though its contribution is substantially smaller than that of traditional risk factors such as hypertension.
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