Effect of Helicobacter pylori eradication on the prognosis of older patients with chronic heart failure: a multicenter, retrospective cohort study

Yuehua Chen, P P Li, Yi Zhou, L J Zhao, Shengyi Yang, Xiaodong Zhang, Lumucao Bai, Jingwen Yuan, Mengru Wu, Xin Hu, Liu S

Background The current management of chronic heart failure (CHF) in older patients primarily focuses on traditional cardiovascular risk factors, with inadequate consideration of chronic infections such as Helicobacter pylori (H. pylori) . This study aimed to examine whether H. pylori eradication was associated with the prognosis of older patients with CHF and to identify potential factors. Methods This multicenter, retrospective cohort study enrolled inpatients aged 55 years and older with Stage C heart failure and H. pylori infection from four hospitals (2022–2023). Participants were divided into the H. pylori eradication group and the non-eradication group. A 1:1 propensity score matching (PSM) was employed to construct a balanced cohort. The primary outcome was a composite endpoint of death due to heart failure and readmission for worsening heart failure. Kaplan-Meier and Log-Rank tests assessed survival differences, and Cox regression analysis identified potential factors. Subgroup and sensitivity analyses were also performed. Results Among 191 patients, 50 (26.18%) experienced the composite endpoint during a median follow-up of 19.7 months. After 1:1 PSM, a well-balanced cohort of 156 patients (78 per group) was established, with 41 endpoint events (26.28%) recorded. Kaplan-Meier analysis showed higher event-free survival in the eradication group both before and after matching ( P < 0.05). Multivariable Cox analysis revealed that H. pylori eradication was independently associated with a lower risk of the composite endpoint (HR: 0.27; 95% CI: 0.13–0.54, P < 0.001), while age ≥65 years and NYHA class III–IV were identified as independent risk factors. Subgroup analysis showed consistent associations across all subgroups ( P for interaction >0.05). Conclusions H. pylori eradication was independently associated with a lower risk of the composite endpoint of heart failure-related readmission and mortality in older patients (aged ≥55 years) with CHF. These findings suggest that H. pylori eradication deserves further investigation to determine its potential role in the comprehensive management of patients with heart failure and concurrent H. pylori infection. Prospective studies are needed to further evaluate the association and explore the underlying mechanisms.