The association between asthma and heart failure – a systematic review and meta-analysis

Background and aim: Asthma and heart failure are highly prevalent diseases with substantial impact on quality of life and life expectancy. Studies have reported on the association between cardiovascular diseases and asthma. The aim of this review is to provide an update on the current evidence for an association between asthma and heart failure (HF) with regard to prevalence and outcome. Methods: A systematic literature search, last updated in ultimo May 2025, was performed on PubMed in accordance with the PRISMA guidelines. The identified articles were systematically screened for eligibility. A random-effects meta-analysis was performed to pool hazard ratios and odds ratios for HF in asthma patients. Results: A total of 11 studies were included. Four studies found that asthma was statistically significantly associated with an increased risk of HF. Two studies found a non-significantly increased risk of HF in asthma patients. The pooled HR for HF incidence in asthma patients was 2.03 (95% CI: 1.55; 2.68). Similarly, the pooled OR was 1.61 (95% CI: 1.09; 2.38). Three studies found increased morbidity and mortality in asthma patients with HF compared to controls. One study showed a non-significant increase in mortality in patients with concomitant asthma and HF, whereas another reported a decreased risk compared to HF alone. Conclusions: The available evidence suggests a significant association between asthma and incident HF, as well as an increased risk of hospitalization in patients with both conditions, even after adjusting for sex, age, and other known cardiovascular risk factors.