Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

Abstract

Background The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). Methods This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. Results A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14–2.51; p = 0.009). Conclusion Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. Trial registration NCT03798457 Registered 10 January 2019 - Retrospectively registered

Prognostic Factors for Cardiovascular Events in Elderly Patients with Community Acquired Pneumonia: Results from the CAP-China Network

“…However, the incidence of CVEs differs as the different inclusion criteria of CVEs. In a multicenter prospective study enrolled 1266 patients with CAP, data indicated that 23.8% of patients experienced at least a CV event (excluded the thromboembolic diseases), 12 higher than that in our study. We considered the gap is mainly related to the low proportion of patients in PSI class IV or V or CURB-65 class 3–5.…”

“…We confirmed previous reports showing that history of heart failure, previously diagnosed coronary artery disease, pleural effusion, multilobe infiltration, age and BUN were independently associated with CVEs. 12 , 16 , 23–26 In the first analysis of prospectively collected data from the Pneumonia Patient Outcomes Team cohort study in patients with CAP, sodium<130 mmol/L was considered as independent risk factor for incident cardiac complications. 25 In our data, level of blood sodium (OR 0.98; 95% CI, 0.97–0.99, p =0.007) was protective factor for the occurrence of CVEs, suggesting the similar conclusion.…”

CHA2DS2-VASc Score for Major Adverse Cardiovascular Events Stratification in Patients with Pneumonia with and without Atrial Fibrillation

“…The mechanisms of pneumonia-associated cardiovascular complications included hypoxia, proinflammatory status, platelet activation, thrombosis formation, unstable plaque, increased sympathetic tone, and several adverse effects of antibiotics [ 11 , 17 , 18 , 19 ]. As most of the MACEs were due to thromboembolic events, we investigated the CHA2DS2-VASc score to predict MACE.…”

“…A previous study showed that approximately 10–15% of patients developed heart failure after pneumonia infection [ 6 , 17 ]. Although the mechanism is unclear, several hypotheses have been proposed, including persistent inflammatory state, hypoxia, tachycardia, specific microbacteria, and fluid overload during the management of pneumonia infection [ 4 , 10 , 21 , 22 ].…”

“…First, the database was primarily used for insurance reimbursement; therefore, it did not contain any physiological and laboratory data of the studied patients. We did not know the severity of the disease, such as C-reactive protein level, the pneumonia severity index, CURB-65, Modified Early Warning Score, and sequential organ failure assessment, which are associated with MACE occurrence and mortality [ 3 , 7 , 8 , 17 , 21 , 22 ]. Moreover, the severity of underlying heart failure such as ejection fraction of left and right ventricle of the patient could not be determined from the database.…”