Pneumonia Incidence High, Associated With Increased Mortality in HF Patients

American College of Cardiology

Pneumonia incidence is high in patients with heart failure (HF), particularly HF with preserved ejection fraction (HFpEF), and associated with an increased mortality risk, according to a study published April 19 in the Journal of the American College of Cardiology .

Li Shen, MBChB, PhD, FACC, et al., looked at the rate and impact of pneumonia in the PARADIGM-HF and PARAGON-HF trials, both of which compared use of sacubitril/valsartan with a renin-angiotensin system blocker. Specifically, the researchers analyzed incidence of investigator-reported pneumonia and rates of HF hospitalization, cardiovascular death, and all-cause death before and after pneumonia, as well as the estimated risk of death after the first occurrence of pneumonia. Pneumonia patients were compared to patients with urinary tract infections (UTIs). The primary endpoint was the time to the first occurrence of HF hospitalization or cardiovascular death.

The results show that 528 patients (6.3%) and 510 patients (10.6%) in PARADIGM-HF and PARAGON-HF trials, respectively, developed pneumonia. Patients who developed pneumonia were older and more likely to be male than those who did not. In addition, patients who developed pneumonia were more likely to have chronic obstructive pulmonary disease, diabetes and atrial fibrillation.

In both the PARADIGM-HF and PARAGON-HF trials, the first month following a pneumonia episode was associated with an elevated risk of all trial outcomes. The adjusted hazard ratio (aHR) for the risk of death from any cause in PARADIGM-HF was 4.34 (95% CI: 3.73-5.05) and in PARAGON-HF was 3.76 (95% CI: 3.09-4.58). Use of sacubitril/valsartan did not reduce the risk of pneumonia in either trial. In the comparison group of patients with UTIs, the risks of the primary outcome and either cardiovascular or all-cause death were higher following infection, but the risk was substantially lower than for patients with pneumonia.

According to the researchers, the study demonstrates an “association between pneumonia and worse outcomes” in patients with HF. They note that “there seems little doubt that prevention of pneumonia is important in patients with HF,” adding that HF guidelines advocate pneumonia vaccination. The study showed a high incidence of pneumonia in patients with HF, especially in those with HFpEF, they note. “An episode of pneumonia was of considerable prognostic importance, as it was associated with an approximately fourfold elevation in risk of death,” they conclude.

In an accompanying editorial comment, Donna Mancini, MD, and Gregory T. Gibson, MD, note that the study’s “novel finding” is the “persistent risk beyond three months” following pneumonia. They note that pneumonia vaccination in HF patients may help improve outcomes. “Although vaccination alone appears unlikely to be a panacea, it is a readily accessible tool for mitigating disease severity and improving outcomes. After all, an ounce of prevention is worth a pound of cure,” they conclude.

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