Poor pneumonia outcomes among patients with heart failure (HF) were associated with acute and not chronic HF exacerbations, according to results of a study published in the American Journal of Medicine Open.

This retrospective cohort study evaluated data from the Premier Database which comprised patients (N=783,702) with pneumonia admitted to 651 hospitals in the United States between 2010 and 2015. Outcomes and mortality were evaluated on the basis of the presence and severity of HF.

The study population was aged median 72 (IQR, 59-83) years, 51.5% were women, 74.5% were White, and 71.2% were covered by Medicare. Most patients (n=571,499) did not have HF, 212,203 had HF of whom 26.5% had acute HF, 22.7% chronic HF, and 51% had unspecified status. In general, patients with HF were older (median, 78 vs 70 years) and had higher comorbidity scores (median, 5 vs 2; P <.001).


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During hospitalization, patients with HF were more likely to be treated with beta blockers (67.1% vs 37.1%; P <.001), angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB; 38.8% vs 26.6%; P <.001), loop diuretics (76.6% vs 29.4%; P <.001), and anti-arrhythmic medications (13.8% vs 5.9%; P <.001). Among the patients with HF, more with acute HF received beta blockers, ACEi or ARB, digoxin, hydralazine, thiazide, and loop diuretics than patients with chronic HF (all P <.001).

HF was associated with higher mortality (13.2% vs 8.1%; P <.001), acute kidney injury (34.1% vs 21%; P <.001), longer hospital stays (median, 6 vs 5 days; P <.001), transfer to the intensive care unit (41.3% vs 27.7%; P <.001), need for mechanical ventilation (21.4% vs 12.9%; P <.001), and increased costs (median, $11,709 vs $8175; P <.001).

In the multivariate analysis, acute HF was associated with increased risk for inpatient mortality (odds ratio [OR], 1.19; 95% CI, 1.15-1.22; P <.001) and chronic HF was associated with decreased inpatient morality risk (OR, 0.92; 95% CI, 0.89-0.96; P <.001).

This study was limited by the high proportion of patients with unspecified HF severity.

“…patients with HF admitted for pneumonia are significantly sicker and have a worse prognosis and higher cost that those without HF. This is especially true among those with acute HF and this subgroup appears responsible for the worse outcomes observed, including increased mortality,” the study authors wrote. “Further studies are needed to understand the paradoxical finding of lower adjusted mortality among patients with chronic HF only.”

Reference

Hariri E, Patel NG, Bassil E, et al. Acute but not chronic heart failure is associated with higher mortality among patients hospitalized with pneumonia: An analysis of a nationwide database. AJM Open. Published online May 5, 2022. doi:10.1016/j.ajmo.2022.100013