The impact of pre-existing heart failure on pneumonia prognosis: population-based cohort study.
BACKGROUND
There are limited data describing how pre-existing heart failure affects mortality following pneumonia.


OBJECTIVE
To examine the association between history and severity of heart failure and mortality among patients hospitalized for pneumonia.


METHODS
Population-based cohort study in Western Denmark between 1994 and 2003.


METHODS
33,736 adults with a first-time hospitalization for pneumonia. Heart failure was identified and categorized based on data linked from population-based health care databases.


METHODS
We compared 30-day mortality between patients with pre-existing heart failure and other pneumonia patients, while adjusting for age, gender, comorbidity, and medication use.


RESULTS
The 30-day mortality was 24.4% among heart-failure patients and 14.4% among other patients, with an adjusted 30-day mortality rate ratio (MRR) of 1.40 (95% CI: 1.29-1.51). Adjusted MRRs increased according to severity of pre-existing heart failure, as indicated by medication regimen: thiazide-based, MRR = 1.09 (95% CI: 0.79-1.50); loop-diuretics, MRR = 1.25 (95% CI: 1.10-1.43); loop-diuretics and digoxin, MRR = 1.35 (95% CI: 1.18-1.55); loop-diuretics and spironolactone, MRR = 1.72 (95% CI: 1.49-2.00). Pre-existing heart valve disease and atrial fibrillation substantially increased mortality.


CONCLUSIONS
History and severity of heart failure are associated with a poor outcome for patients hospitalized with pneumonia.
Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark. r.thomsen@rn.dk
Reimar W
RW
Thomsen
Nongyao
N
Kasatpibal
Anders
A
Riis
Mette
M
Nørgaard
Henrik T
HT
Sørensen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000401:mortality*; D012189:Retrospective Studies