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Relation of Cardiac Complications in the Early Phase of Community-Acquired Pneumonia to Long-Term Mortality and Cardiovascular Events

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Community-acquired pneumonia (CAP) is complicated by cardiac events in the early phase of the disease. Aim of this study was to assess if these intrahospital cardiac complications may account for overall mortality and cardiovascular events occurring during a long-term follow-up. Three hundred one consecutive patients admitted to the University-Hospital, Policlinico Umberto I, with community-acquired pneumonia were prospectively recruited and followed up for a median of 17.4 months. Primary end point was the occurrence of death for any cause, and secondary end point was the occurrence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction [MI], and stroke). During the intrahospital stay, 55 patients (18%) experienced a cardiac complication. Of these, 32 had an MI (29 non–ST-elevation MI and 3 ST-elevation MI) and 30 had a new episode of atrial fibrillation (7 nonmutually exclusive events). During the follow-up, 89 patients died (51% of patients with an intrahospital cardiac complication and 26% of patients without, p <0.001) and 73 experienced a cardiovascular event (47% of patients with and 19% of patients without an intrahospital cardiac complication, p <0.001). A Cox regression analysis showed that intrahospital cardiac complications, age, and Pneumonia Severity Index were significantly associated with overall mortality, whereas intrahospital cardiac complications, age, hypertension, and diabetes were significantly associated with cardiovascular events during the follow-up. In conclusion, this prospective study shows that intrahospital cardiac complications in the early phase of pneumonia are associated with an enhanced risk of death and cardiovascular events during long-term follow-up.

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Methods

The study was conducted at the University-Hospital Policlinico Umberto I (Rome, Italy). All patients admitted to medical wards with diagnosis of CAP through the emergency department from January 2011 to December 2014 were consecutively recruited and prospectively followed up. Patients who fulfilled the following criteria were enrolled in the study after giving written informed consent: (1) age ≥18 years; (2) clinical presentation of an acute illness with one or more of the following signs or

Results

We recruited 301 patients hospitalized for CAP (187 men and 114 women; age 71.8 ± 15.7 years). Most of the patients had arterial hypertension (70%). T2DM was present in 26%, chronic obstructive pulmonary disease in 34%, dyslipidemia in 24%, and a history of stroke in 12%. A history of paroxysmal atrial fibrillation was present in 14% of patients, whereas 12% were affected by chronic (persistent or permanent) atrial fibrillation and 13% had severe chronic kidney disease (i.e., a glomerular

Discussion

This study shows that cardiac complications occurring during the acute phase of hospitalization are associated with an enhanced risk of total mortality and CVEs in a follow-up of 2 years. Recent studies demonstrated that the early phase of pneumonia is complicated by cardiac events including acute coronary syndromes and arrhythmias, such as AF.4, 12, 13 Consistently with these reports, ∼20% of our population experienced MI and/or AF in the early phase of acute disease. Although the association

Disclosures

This work was supported by a grant from the Sapienza University of Rome, Rome, Italy (“Ricerche Universitarie” 2013, n. C26A13W5JX) to Prof. F. Violi. All the authors have no conflicts of interest to disclose.

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