title: Intermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults.
abstract: BACKGROUND
  Pneumonia is associated with high risk of heart failure (HF) in the short term (30 days) postinfection. Whether this association persists beyond this period is unknown.
  
  
  METHODS
  We studied 5,613 elderly (≥65 years) adults enrolled in the Cardiovascular Health Study between 1989 and 1994 at 4 US communities. Participants had no clinical diagnosis of HF at enrollment, and they were followed up through December 2010. Hospitalizations for pneumonia were identified using validated International Classification of Disease Ninth Revision codes. A centralized committee adjudicated new-onset HF events. Using Cox regression, we estimated adjusted hazard ratios (HRs) of new-onset HF at different time intervals after hospitalization for pneumonia.
  
  
  RESULTS
  A total of 652 participants hospitalized for pneumonia during follow-up were still alive and free of clinical diagnosis of HF by day 30 posthospitalization. Relative to the time of their hospitalization, new-onset HF occurred in 22 cases between 31 and 90 days (HR 6.9, 95% CI 4.46-10.63, P < .001), 14 cases between 91 days and 6 months (HR 3.2, 95% CI 1.88-5.50, P < .001), 20 cases between 6 months and 1 year (HR 2.6, 95% CI 1.64-4.04, P < .001), 76 cases between 1 and 5 years (HR 1.7, 95% CI 1.30-2.12, P < .001), and 71 cases after 5 years (HR 2.0, 95% CI 1.56-2.58, P < .001). Results were robust to sensitivity analyses using stringent definitions of pneumonia and extreme assumptions for potential informative censoring.
  
  
  CONCLUSIONS
  Hospitalization for pneumonia is associated with increased risk of new-onset HF in the intermediate and long term. Studies should characterize the mechanisms of this association in order to prevent HF in elderly pneumonia survivors.
authors: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: vcorrales@toh.on.ca.
authors: Vicente F
authors: VF
authors: Corrales-Medina
authors: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors: Monica
authors: M
authors: Taljaard
authors: Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors: Sachin
authors: S
authors: Yende
authors: Department of Statistics. University of Washington, Seattle, WA.
authors: Richard
authors: R
authors: Kronmal
authors: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors: Girish
authors: G
authors: Dwivedi
authors: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
authors: Anne B
authors: AB
authors: Newman
authors: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors: Mitchell S V
authors: MS
authors: Elkind
authors: Department of Medicine, Wake Forest University, Winston-Salem, NC.
authors: Mary F
authors: MF
authors: Lyles
authors: University of Pennsylvania, Philadelphia, PA; Philadelphia VA Medical Center, Philadelphia, PA.
authors: Julio A
authors: JA
authors: Chirinos
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D010359:Patient Readmission / Q000639:trends; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors