About 1 in 4 patients hospitalized for community acquired pneumonia (CAP) will suffer a cardiovascular (CV) event, most often within the first 3 days of hospitalization, according to a retrospective analysis published in BMC Infectious Diseases. The observational study found that CV events are associated with increased 30-day mortality rates, hospital stays, and 30-day rehospitalization rates, significantly adding to the burden of CAP care.
Investigators analyzed data from adult patients enrolled in the Implications of acute Cardiovascular Events in patients hospitalized for Community-Acquired Pneumonia (ICECAP; Clinicaltrials.gov Identifier: NCT03798457) study.
Researchers used the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, and age older than 65 years, and Pneumonia Severity Index scores to assess CAP severity. They primarily aimed to quantify the incidence of CV events in patients, which included newly diagnosed heart failure, acute coronary syndrome, new-onset atrial fibrillation or flutter, new-onset ventricular arrhythmias, new-onset 2nd or 3rd AV block, and new-onset hemorrhagic or ischemic stroke, or transient ischemic attack. They also analyzed data gathered on 30-day mortality and rehospitalization rates.
Of the 1266 patients included in the analysis, the median age was 79 (IQR, 71-86), males and females were equally represented, and patients had a high prevalence of comorbidities and elevated pneumonia severity scores. During hospitalization, 301 (23.8%) patients had at least 1 CV event, including 196 (15.5%) patients with newly-diagnosed heart failure, 111 (8.7%) patients with atrial fibrillation or flutter, 34 (2.7%) with acute coronary syndrome, and 11 (0.8%) with ischemic stroke or transient ischemic attack. For 75% of these patients, CV events occurred within 3 days of admission; in 56.8% of patients, CV events occurred within the first day of admission.
Investigators found that female gender (P =.0001), a history of CV disease (P =.0001), Pneumonia Severity Index greater than 130 (P =.0001), and the presence of pleural effusion (P =.028) significantly increased the risk of CV events occurring during CAP hospitalization. Acute kidney injury was an independent risk factor for CV events (P =.003).
Data revealed that rate of in-hospital mortality was 12.2% vs 4.7% in patients with and without CV events, respectively (P <.0001). The 30-day mortality rate was 16.3% vs 8.9% in patients with and without CV events, respectively (P =.0001). Mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days in patients with and without CV events, respectively (P <.0001), and rehospitalization rates were 13.3% vs 9.3% in patients with and without CV events, respectively (P =.002). Additionally, investigators found the occurrence of any CV event during hospitalization independently and significantly increased the 30-day mortality rate when adjusted for other variables, such as pneumonia severity and comorbidities (hazard ratio, 1.69; 95% CI, 1.14%-2.51%; P =.009).
This multicenter study was limited by the lack of standardized CAP management and the exclusion of antimicrobial treatments from statistical analysis of outcome measures.
Based on these results, the study authors concluded that clinicians should have heightened awareness for the probability of a CV event, especially in higher risk patients, such as those who are over age 75, have a history of CV disease, or present with severe pneumonia.
“CV events should be regarded as a common and unfavorable complication of CAP…together with more classical but less frequent complications, such as pleural empyema and pulmonary abscesses,” the study authors wrote.
They suggested ECG monitoring or telemetry during the first 3 to 4 days of CAP admission for higher risk patients.
Pieralli F, Vannucchi V, Nozzoli C, et al; for the FADOI-ICECAP Study Group. Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study. BMC Infect Dis. Published online January 25, 2021. doi:10.1186/s12879-021-05781-w