Cardiovascular events significantly increase mortality in pneumonia

Nearly a third of patients hospitalized for community-acquired pneumonia experienced complications from cardiovascular events, study data showed.

Patients who experienced cardiovascular events had a fivefold greater mortality rate than those who did not experience those events.

“Recent studies documented a frequent association between community-acquired pneumonia and the occurrence [of] acute cardiac complications such as heart failure, atrial fibrillation and myocardial infarction,” Francesco Violi, MD, of the department of internal medicine and medical specialties at Sapienza University of Rome, Italy, and colleagues wrote. “Moreover, the occurrence of these complications in patients with community-acquired pneumonia has been associated with increased short- and long-term mortality. However, there is still uncertainty regarding the actual incidence of these complications as it has varied widely in studies that have used different designs and criteria to define these complications.”

Violi and colleagues performed a multicenter study on 1,182 patients with community-acquired pneumonia. The researchers followed patients for up to 30 days after hospital admission. Endpoints were myocardial infarction, new or worsening heart failure, deep venous thrombosis, stroke, atrial fibrillation, cardiovascular death and total mortality. Six hundred ninety-eight patients were male, and mean age was 73 years. Sixty-five percent of patients had hypertension, 38% had a history of coronary heart disease, 29% had a history of heart failure and 12% had a history of stroke.

Three hundred eighty (32.2%) patients experienced cardiovascular events while in the hospital, the researchers reported. Two hundred eighty-one (23.8%) had heart failure, 109 (9.2%) had atrial fibrillation, 89 (8%) had myocardial infarction, 11 (0.9%) had ischemic stroke and 1 (0.1%) had deep vein thrombosis. Twenty-eight patients (2.4%) died of cardiovascular causes.

Pneumonia severity index classes III, IV and V (HR = 2.45; P = .027; HR = 4.23; P < .001 and HR = 5.96; P < .001, respectively) independently predicted cardiovascular events, according to a multivariable Cox regression analysis, as did age (HR = 1.02; P = .001) and pre-existing heart failure (HR = 1.85; P < .001). One hundred three patients (8.7%) died by 30 days after admission. Those who experienced cardiovascular events had a significantly higher mortality rate than those who did not (17.6% vs. 4.5%; P < .001). Intra-hospital cardiovascular events were independently predictive of the 30-day mortality rate after adjustment for age, pneumonia severity index score and pre-existing comorbid conditions, according to multivariable Cox regression analysis (HR = 5.49; P < .001).

“In conclusion, the present study demonstrates that cardiovascular events complicate a substantial proportion of hospitalized community-acquired pneumonia cases and that their occurrence significantly increases the mortality associated with this infection,” the researchers wrote. “This suggests that community-acquired pneumonia should be regarded not only as a disease limited to the lung but also as a systemic illness that commonly and negatively affects the cardiovascular system. Awareness of this association should prove useful for the clinical management of community-acquired pneumonia and for the planning of interventional trials aimed at improving the outcomes of patients with this infection.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.