Pneumonia incidence elevated in patients with HF, particularly HFpEF
Pneumonia incidence was high in patients with HF and especially high in those with HF with preserved ejection fraction, according to new data from the PARADIGM-HF and PARAGON-HF trials.
“An episode of pneumonia was of considerable prognostic importance, as it was associated with an approximately fourfold elevation in risk of death,” Li Shen, MD, MBChB, PHD, with the School of Medicine, Hangzhou Normal University, China, and colleagues wrote.
The researchers analyzed 8,399 patients with HF with reduced ejection fraction from PARADIGM-HF, 6.3% of whom contracted pneumonia, and 4,976 patients with HFpEF from PARAGON-HF, 10.6% of whom contracted pneumonia.
In the HFrEF cohort, the incidence rate of pneumonia was 29 per 1,000 patient-years (95% CI, 27-32), and in the HFpEF cohort, it was 39 per 1,000 patient-years (95% CI, 36-42), Shen and colleagues wrote, noting that compared with the general population, the incidence rates were consistent with those for people aged 80 years or older, but much higher than those for those aged 65 to 79 years.
In both cohorts, those who contracted pneumonia were older than those who did not (PARADIGM-HF: 67 years vs. 63.6 years; PARAGON-HF: 76 years vs. 72.4 years; P for both < .001). In PARADIGM-HF, men were more likely to get pneumonia than women, but in PARAGON-HF, there was no difference between the sexes, according to the researchers.
According to the researchers, the rate for death from any cause was 7.4 per 100 patient-years before pneumonia compared with 39.5 per 100 patient-years after pneumonia (adjusted HR in PARADIGM-HF = 4.34; 95% CI, 3.73-5.05; aHR in PARAGON-HF = 3.76; 95% CI, 3.09-4.58).
“The novel finding of the study was that, although the greatest risk to patients occurred in the month following the acute pneumonia episode, there was a persistent risk beyond 3 months. Acutely, increased alveolar fluid in heart failure could impair bacterial clearance and affect local defense mechanisms, resulting in pneumonia, but previous research also implicated dysregulation of inflammatory pathways and decreased nitric oxide production with resulting endothelial dysfunction,” Donna Mancini, MD, professor of medicine at Icahn School of Medicine at Mount Sinai, New York, and Gregory T. Gibson, MD, clinical fellow at The Mount Sinai Hospital, wrote in a related editorial.