Cardiac Complications in Patients with Community Acquired Pneumonia: Incidence, Timing, Risk Factors, and Association with Short-Term Mortality
Background—Community acquired pneumonia (CAP) affects >5 million adults each year in the United States. Although incident cardiac complications occur in patients with CAP, their incidence, timing, risk factors and associations with short-term mortality are not well understood.
Methods and Results—1343 inpatients and 944 outpatients with CAP were followed prospectively for 30 days after presentation. Incident cardiac complications (new or worsening heart failure, new or worsening arrhythmias or myocardial infarction) were diagnosed in 358 (26.7%) inpatients and 20 (2.1%) outpatients. While most events (89.1% in inpatients, 75% in outpatients) were diagnosed within the first week, over half of them were recognized in the first 24h. Factors associated with their diagnosis included older age (OR=1.03; 95%CI:1.02-1.04), nursing home residence (OR=1.8; 95%CI:1.2-2.9), history of heart failure (OR=4.3; 95%CI:3.0-6.3), prior cardiac arrhythmias (OR=1.8; 95%CI:1.2-2.7), previously diagnosed coronary artery disease (OR=1.5; 95%CI:1.04-2.0), arterial hypertension (OR=1.5; 95%CI:1.1-2.1), respiratory rate≥30/min (OR=1.6; 95%CI:1.1-2.3), blood pH<7.35 (OR=3.2; 95%CI:1.8-5.7), blood urea nitrogen≥30mg/dl (OR=1.5; 95%CI:1.1-2.2), serum sodium<130mmol/liter (OR=1.8; 95%CI:1.02-3.1), hematocrit<30% (OR=2.0; 95%CI:1.3-3.2), pleural effusion on presenting chest-X-ray (OR=1.6; 95%CI:1.1-2.4), and inpatient care (OR=4.8; 95%CI:2.8-8.3). Incident cardiac complications were associated with increased risk of death at 30-days after adjustment for baseline pneumonia severity index-score (OR=1.6; 95%CI:1.04-2.5).
Conclusions—Incident cardiac complications are common in patients with CAP and are associated with increased short-term mortality. Older age, nursing home residence, pre-existing cardiovascular disease and pneumonia severity are associated with their occurrence. Further studies are required to test risk stratification, prevention and treatment strategies for cardiac complications in this population.
- Received May 13, 2011.
- Accepted December 20, 2011.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited