title: Chronic heart failure and mortality in patients with community-acquired Staphylococcus aureus bacteremia: a population-based cohort study.
abstract: Patients with chronic heart failure (CHF) may experience higher mortality of Staphylococcus aureus bacteremia (SAB) than patients without CHF due to insufficient cardiovascular responses during systemic infection. We investigated 90-day mortality in SAB patients with and without CHF.
  
  
  
  Using population-based medical databases, we conducted a cohort study of all adult patients with community-acquired SAB (CA-SAB) in Northern Denmark, 2000-2011. Ninety-day mortality after SAB for patients with and without CHF was estimated by the Kaplan-Meier method. Based on Cox regression analysis, we computed hazard ratios as estimates of mortality rate ratios (MRRs) overall and stratified by CHF-related conditions (e.g., cardiomyopathy and valvular heart disease), CHF severity (defined by daily dosage of loop-diuretics), and CHF duration while adjusting for potential confounders.
  
  
  
  Among 2638 SAB patients, 390 (14.8 %) had a history of CHF. Ninety-day mortality was 45 % in patients with CHF and 30 % in patients without CHF, which yielded an adjusted MRR (aMRR) of 1.24 (95 % CI, 1.04-1.48). Compared to patients without CHF, the excess risk of death was most pronounced among patients with valvular heart disease (aMRR = 1.73 (95 % CI, 1.26-2.38)), patients with daily loop-diuretic dosages of 81-159 mg/day (aMRR = 1.55 (95 % CI, 1.11-2.14)) and ≥160 mg/day (aMRR = 1.62 (95 % CI, 1.21-2.18)), and among patients with <3 years of CHF duration (aMRR = 1.43 (95 % CI, 1.14-1.78)).
  
  
  
  CA-SAB patients with CHF experienced increased 90-day mortality compared to patients without CHF.
authors.affiliation: Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark. jesm@rn.dk.|Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, P.O. Box 365, DK-9100, Aalborg, Denmark. jesm@rn.dk.|Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark. jesm@rn.dk.
authors.forename: Jesper
authors.initials: J
authors.lastname: Smit
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark.|Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Adelborg
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark.
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Søgaard
authors.affiliation: Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000, Aalborg, Denmark.
authors.forename: Henrik Carl
authors.initials: HC
authors.lastname: Schønheyder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000209:etiology / Q000401:mortality*; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications* / Q000382:microbiology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000502:physiology
keywords: Bacteremia; Congestive heart failure; Mortality; Prognosis; Staphylococcus aureus