Gastroparesis in heart failure: temporal trends, clinical correlates, and outcomes in a large national cohort

Gastrointestinal complications of heart failure are increasingly recognized, but the epidemiology and clinical significance of gastroparesis in this population remain poorly defined. We evaluated a national multicenter cohort of adults with heart failure to characterize temporal trends in gastroparesis incidence, identify factors associated with its development, and assess its association with clinical outcomes. We used a national multicenter database to identify adults diagnosed with heart failure from 2005 to 2025. Temporal trends in gastroparesis incidence were evaluated at 5-year intervals, multivariable Cox proportional hazards regression was used to identify factors associated with its development, and 5-year cardiorenal and healthcare utilization outcomes were compared between patients with and without gastroparesis. Among 3,913,826 patients with heart failure, gastroparesis incidence increased more than tenfold during the study period, from 35.6 to 402.3 cases per 100,000 person-years. Diabetes mellitus [hazard ratio (HR) =4.54], chronic mesenteric ischemia (HR =2.16), ascites (HR =1.55), and heart failure with preserved ejection fraction (HR =1.60) were independently associated with gastroparesis. Patients with concomitant gastroparesis experienced significantly higher risks of major adverse cardiovascular events (MACE) [31.8% vs. 19.7%; odds ratio (OR) =1.90; 95% confidence interval (CI): 1.80–1.99; P<0.001], acute kidney injury, end-stage renal disease, emergency department visits, and intensive care unit admission (38.9% vs. 22.6%; OR =2.19; 95% CI: 2.11–2.27; P<0.001). These findings identify gastroparesis as an increasingly recognized comorbidity in patients with heart failure that may represent a high-risk phenotype. The observed associations further suggest that venous congestion and impaired splanchnic perfusion may contribute to the development of gastric dysmotility in this population.