Fudim M, Zhong L, Patel KV, et al. - Findings demonstrate an elevated risk of incident heart failure (HF) among nonalcoholic fatty liver disease (NAFLD) patients, and the risk of developing HF with preserved ejection fraction was higher than that for HF with reduced ejection fraction. Post-adjustment for clinical and demographic factors, an elevated risk persisted, indicating an epidemiological association between NAFLD and HF beyond the basis of shared risk factors.

• In this retrospective cohort study among 870,535 Medicare beneficiaries without known prior diagnosis of HF, the independent link between NAFLD and downstream risk of HF and HF subtypes was investigated.

• A clinical diagnosis of NAFLD was received by 3.2% (N=27 919).

• A significantly higher risk of new‐onset HF was observed in patients with (vs without) baseline NAFLD in unadjusted (6.4% vs 5.0%) and adjusted (adjusted hazard ratio [HR] [95% CI], 1.23 [1.18–1.29]) analyses, over a mean 14.3 months of observation.

• A stronger link of NAFLD with downstream risk of HF was observed for HF with preserved ejection fraction (adjusted HR [95% CI], 1.24 [1.14–1.34]) vs HF with reduced ejection fraction (adjusted HR [95% CI], 1.09 [0.98–1.2]).