Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

Abstract

Acute cardiovascular disease after community-acquired pneumonia is a well-accepted complication for which definitive treatment strategies are lacking. These complications share some common features but have distinct diagnostic and treatment approaches. We therefore undertook an updated systematic review and meta-analysis of observational studies reporting the incidence of overall complications, acute coronary syndromes, new or worsening heart failure, new or worsening arrhythmias and acute stroke, as well as short-term mortality outcomes. To set a framework for future research, we further included a holistic review of the interplay between the two conditions. From 1984 to 2019, thirty-nine studies were accrued, involving 92,188 patients, divided by setting (inpatients versus outpatients) and clinical severity (low risk versus high risk). Overall cardiac complications occurred in 13.9% (95% confidence interval (CI) 9.6–18.9), acute coronary syndromes in 4.5% (95% CI 2.9–6.5), heart failure in 9.2% (95% CI 6.7–12.2), arrhythmias in 7.2% (95% CI 5.6–9.0) and stroke in 0.71% (95% CI 0.1–3.9) of pooled inpatients. During this period, meta-regression analysis suggests that the incidence of overall and individual cardiac complications is decreasing. After adjusting for confounders, cardiovascular events taking place after community-acquired pneumonia independently increase the risk for short-term mortality (range of odds-ratio: 1.39–5.49). These findings highlight the need for effective, large trial based, preventive and therapeutic interventions in this important patient population.

History of coronary heart disease increases the mortality rate of COVID-19 patients: a nested case-control study

“…Previous studies have indicated that cardiovascular events following pneumonia may increase the risk of mortality [35][36][37][38][39][40][41], which explained our findings from the point view of pathophysiological mechanisms. One potential mechanism underlying the association between pneumonia and cardiovascular events is inflammation [38].…”

A Review of the Risk Factors Associated With Poor Outcomes in Patients With Coronavirus Disease 2019

“…Neurological manifestations including acute cerebrovascular diseases (5.7%), were found more in patients with severe condition with COVID-19 as reported Mao et al [27]. A meta-analysis of observational studies from Tralhao et al [28] reported that the incidence of acute stroke was 0.71% in pooled inpatients. Avula et al [29] reported a series of four COVID-19 patients with acute stroke as a presenting symptom.…”

Clinical and financial burden of hospitalised community-acquired pneumonia in patients with selected underlying comorbidities in England

“…A recent systematic review and meta-analysis reported an increased risk of myocardial infarction, heart failure, dysrhythmias and stroke after CAP, which is maximal in the acute phase but persists long-term after resolution of the pneumonia . 23 The finding that there is an increased likelihood of mortality following an episode of hospitalised CAP is reflected by a study in Dutch adults which suggested long-term mortality was higher in those with an underlying comorbidity following an episode of IPD or pneumonia. 24 A possible explanation for this is that an episode of hospitalised CAP can compromise the long-term health status of patients with underlying comorbidities.…”