Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease

Abstract

BackgroundRecent evidence demonstrates increased short-term risk of cardiac complications and respiratory failure among patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD), respectively, concurrent with an episode of community-acquired pneumonia (CAP). We evaluated patients with pre-existing HF or COPD, beginning 30 days after CAP diagnosis, to determine if CAP had a prolonged impact on their underlying comorbidity.MethodsA retrospective matched-cohort design using US healthcare claims was employed. In each month of accrual, patients with HF or COPD who developed CAP (“CAP patients”) were matched (1:1, without replacement, on demographic and clinical profiles) to patients with HF or COPD who did not develop CAP (“comparison patients”). All patients were aged ≥40 years, and were pneumonia free during prior 1-year period. Exacerbation beginning 30 days after the CAP diagnosis and for the subsequent 1-year period were compared between CAP and comparison patients.Findings38,010 (4·6%) HF patients and 48,703 (5·9%) COPD patients experienced a new CAP episode requiring hospitalization or outpatient care only, and were matched to comparison patients. In the HF subset, CAP patients were 47·2% more likely to experience an exacerbation vs patients without CAP (17·8% vs. 12·1%; p<0·001); in the COPD subset, CAP patients were 42·3% more likely to experience an exacerbation (16·2% vs. 11·4%; p<0·001).ConclusionsOur data provide evidence that CAP foreshadows a prolonged increase in risk of exacerbation of underlying HF or COPD in adults, and suggests a potential benefit to CAP prevention strategies.

The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan

“…Hypoimmunity of the elderly patient with CKD may predispose the patient to acute lower respiratory infections. Another study demonstrated that cardiovascular function declined in elderly patients with heart disease, which would affect the mucociliary clearance functions that trap and remove particulates and pathogens from the airways, leading to an increased risk of incident pneumonia [ 35 ]. Furthermore, a population-based cohort study indicated that GERD is associated with a long-term risk of pneumonia, especially in GERD with proton pump inhibitors (PPIs) for a longer treatment than four months [ 36 ].…”

Vacunación neumocócica conjugada en adultos. Recomendaciones de las Sociedades Médicas en México

“…La prevención de la neumonía en pacientes con enfermedades cardíacas podría alterar los resultados a largo plazo y además se deben abordar los mecanismos subyacentes, como la inflamación crónica y/o la activación plaquetaria, ya que podrían alterar la frecuencia de las exacerbaciones de la insuficiencia cardíaca o la EPOC. 33 En otro estudio, se observó que de los pacientes hospitalizados por neumonía, 206 (34.85%) tuvieron eventos cardiovasculares en un período mayor a 10 años después de la hospitalización por neumonía. De éstos, 104 casos (50.5%) tuvieron infarto de miocardio, 35 casos (17%) tuvieron ataque cardíaco y 67 (32.5%) tuvieron eventos coronarios mortales.…”

“…34 Dentro de las medidas que se sugieren para prevenir la NAC están la suspensión del tabaquismo, la vacunación contra la influenza y contra la enfermedad neumocócica, 32 ya que se ha observado que la vacunación contra la influenza y contra el neumococo disminuyó la mortalidad global y cardiovascular en adultos mayores añosos, además de reducir el riesgo de hospitalizaciones por neumonía o muerte de todas las causas. 33 La vacunación ha sido relacionada con beneficios, tales como la disminución de eventos coronarios (tanto en la prevención primaria como en la secundaria), reducción de los accidentes cerebrovasculares, disminución en las hospitalizaciones y costos por otras enfermedades, disminución de la mortalidad y morbilidad en todas las edades con factores de riesgo, principalmente entre adultos mayores añosos. 32 La prevención de la neumonía en pacientes con enfermedad cardíaca y pulmonar puede cambiar los resultados a largo plazo.…”

“…32 La prevención de la neumonía en pacientes con enfermedad cardíaca y pulmonar puede cambiar los resultados a largo plazo. 33…”

Immediate and Near Future Prediction of COVID-19 Patients in the U.S. Population Aged 65+ With the Prior Medical Conditions of Hypertension, Cardiovascular and Lung Diseases: Methods, Models and Acute Care Estimates

“…Eighty percent of the U.S. COVID-19 related deaths reported through March 16 th were aged 65+ [4]. Several other U.S. and international research studies have indicated COVID-19 has a strong association with older adults requiring hospitalization if they also possessed any prior underlying medical condition [5][6][7][8][9][10][11].…”