Infection Prevention Matters in Heart Matters

Annually, February is the month in which healthy heart awareness is promoted. With this month now behind us, let us not forget the importance of continuing to promote heart health and disease prevention throughout the year. Professionals in infection prevention (IP) have a unique opportunity to raise awareness of the link between infections and heart disease, as many people do not recognize this link.

Heart infections result from microbial invasion of the heart muscle. Most frequently, these microbes are bacterial or viral, but they may also be fungal.¹ Although people of advanced age are at higher risk for these infections, younger people may also be at risk, depending on their immune status, comorbid conditions, and personal habits.

Intravenous drug abuse is a leading cause of endocarditis in a younger person. Poor dental hygiene and invasive dental procedures may also predispose a younger person to infective endocarditis of both bacterial and fungal origin. Streptococcus species in oral flora may become invasive with these dental risks. Pericarditis may be a secondary infection to viral respiratory, gastrointestinal, or fungal infections. Untreated tuberculosis and tick-borne pathogens add to the risk of bacterial pericarditis. SARS-CoV-2, coxsackievirus, parvovirus, adenovirus, and hepatitis C have all been implicated in viral myocarditis.¹ Environmental pathogens such as parasites and fungi infections can increase the risk of myocarditis in the high-risk person.

For the hospitalized patient, prevention of bloodstream infections, pneumonia, and urinary tract infections serve to reduce the risk of any heart infection. Strict adherence to insertion practices and care and maintenance bundles for central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs) prevent not only single body system infections but also serve as heart disease mitigation strategies. Infection surveillance for all infections allows early identification and treatment of infections that, if not identified early, may lead to serious myocardial compromise.

Mortality risks are not limited to just the acute phase of care. The inflammatory response of an acute infection has been demonstrated to have long-term sequela for risk of heart disease. This is demonstrated in a recent research publication in the Journal of the American Heart Association.² This study evaluated infection-related hospitalizations and the incidence of heart failure in a long-term study, with a median follow-up time of 27 years, in a diverse population of adults from 45 to 64 years. It was identified that patients with infection-related hospitalizations were at higher risk for heart failure with reduced ejection fraction when adjusting for risk variables.² This is one of many more recent studies evaluating the long-term effect of inflammatory responses evoked by infection linked to chronic heart disease. In fact, this increased risk is demonstrated with COVID-19 as well and may have a genetic marker with ABO blood types.³

Promoting heart health includes advocating for vaccines, environmental hygiene, and personal hygiene throughout every month of the year. The IP professional is in a unique position to advocate for these prevention efforts in various health care settings, in the community, with individuals, and by lobbying for public policy. It is a broad net to cast in preventing infection-related heart disease, but it is one that IP professionals are certainly qualified to take on.

References

1. Cleveland Clinic. Heart Infection. Cleveland Clinic/Health Library/ Diseases and Conditions. November 8, 2021. Accessed February 28, 2025. https://my.clevelandclinic.org/health/diseases/22054-heart-infection
2. Molinsky RL, Shah A, Yuzefpolskaya M, et al. Infection‐related hospitalization and incident heart failure: The atherosclerosis risk in communities study. J Am Heart Assoc. 2025;14(3). Accessed February 28, 2025. https://doi.org/10.1161/jaha.123.033877
3. Hilser JR, Spencer NJ, Afshari K, et al. COVID-19 is a coronary artery disease risk equivalent and exhibits a genetic interaction with ABO blood type. Arterioscler Thromb Vasc Biol. 2024;44(11):2321-2333. Accessed February 20, 2025. https://doi.org/10.1161/atvbaha.124.321001