Incidence and Outcomes of Pneumonia in Patients With Heart Failure

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Article

Shen, Li^1,2  Jhund, Pardeep S.²  Anand, Inder S.^3,4  Bhatt, Ankeet S.⁵  Desai, Akshay S.⁵  Maggioni, Aldo P.⁶  Martinez, Felipe A.⁷  Pfeffer, Marc A.⁵  Rizkala, Adel R.⁸  Rouleau, Jean L.⁹  Swedberg, Karl¹⁰  Vaduganathan, Muthiah⁵  Vardeny, Orly^11,12  van Veldhuisen, Dirk J.¹³  Zannad, Faiez^14,15  Zile, Michael R.¹⁶  Packer, Milton¹⁷  Solomon, Scott D.⁵  McMurray, John J., V² 

[1] Hangzhou Normal Univ, Sch Med, Hangzhou, Peoples R China

[2] Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, 126 Univ Pl, Glasgow G12 8TA, Lanark, Scotland

[3] Univ Minnesota, Sch Med, Dept Med, Minneapolis, MN 55455 USA

[4] VA Med Ctr, Minneapolis, MN USA

[5] Brigham & Womens Hosp, Dept Med, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA

[6] Assoc Nazl Med Cardiol Osped Res Ctr, Florence, Italy

[7] Natl Univ Cordoba, Cordoba, Argentina

[8] Novartis Pharmaceut, E Hanover, NJ USA

[9] Univ Montreal, Montreal Heart Inst, Montreal, PQ, Canada

[10] Univ Gothenburg, Dept Mol & Clin Med, Gothenburg, Sweden

[11] Minneapolis Vet Adm Hlth Care Syst, Ctr Care Delivery & Outcomes Res, Minneapolis, MN USA

[12] Univ Minnesota, Minneapolis, MN USA

[13] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[14] Ctr Invest Clin Plurithemat 1433, Nancy, France

[15] Ctr Hosp Reg Univ, French Clin Res Infrastruct Network, Invest Network Initiat Cardiovasc & Renal Clin Tr, INSERM,U1116, Nancy, France

[16] Med Univ South Carolina, Div Cardiol, Ralph H Johnson Dept Vet Affairs Med Ctr, Charleston, SC 29425 USA

[17] Baylor Univ, Med Ctr, Baylor Heart & Vasc Inst, Dallas, TX USA

关键词: heart failure;    incidence;    pneumonia;    risk;    vaccination;   

DOI  :  10.1016/j.jacc.2021.03.001

来源: Elsevier

【 摘 要 】

BACKGROUND The incidence of pneumonia and subsequent outcomes has not been compared in patients with heart failure and reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). OBJECTIVES This study aimed to examine the rate and impact of pneumonia in the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in Heart Failure with Preserved Ejection Fraction) trials. METHODS The authors analyzed the incidence of investigator-reported pneumonia and the rates of HF hospitalization, cardiovascular death, and all-cause death before and after the occurrence of pneumonia, and estimated risk after the first occurrence of pneumonia in unadjusted and adjusted analyses (the latter including N-terminal pro-B-type natriuretic peptide). RESULTS In PARADIGM-HF, 528 patients (6.3%) developed pneumonia after randomization, giving an incidence rate of 29 (95% CI: 27 to 32) per 1,000 patient-years. In PARAGON-HF, 510 patients (10.6%) developed pneumonia, giving an incidence rate of 39 (95% CI: 36 to 42) per 1,000 patient-years. The subsequent risk of all trial outcomes was elevated after the occurrence of pneumonia. In PARADIGM-HF, the adjusted hazard ratio (HR) for the risk of death from any cause was 4.34 (95% CI: 3.73 to 5.05). The corresponding adjusted HR in PARAGON-HF was 3.76 (95% CI: 3.09 to 4.58). CONCLUSIONS The incidence of pneumonia was high in patients with HF, especially HFpEF, at around 3 times the expected rate. A first episode of pneumonia was associated with 4-fold higher mortality. (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF], NCT01035255; Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] With ARB [Angiotensin Receptor Blocker] Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF], NCT01920711) (J Am Coll Cardiol 2021;77:1961-73) (c) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

【 授权许可】

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