Incidence and Outcomes of Pneumonia in Patients With Heart Failure.

Abstract

BACKGROUND:

The incidence of pneumonia and subsequent outcomes has not been compared in patients with heart failure and reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).

OBJECTIVES:

This study aimed to examine the rate and impact of pneumonia in the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in Heart Failure with Preserved Ejection Fraction) trials.

METHODS:

The authors analyzed the incidence of investigator-reported pneumonia and the rates of HF hospitalization, cardiovascular death, and all-cause death before and after the occurrence of pneumonia, and estimated risk after the first occurrence of pneumonia in unadjusted and adjusted analyses (the latter including N-terminal pro-B-type natriuretic peptide).

RESULTS:

In PARADIGM-HF, 528 patients (6.3%) developed pneumonia after randomization, giving an incidence rate of 29 (95% CI: 27 to 32) per 1,000 patient-years. In PARAGON-HF, 510 patients (10.6%) developed pneumonia, giving an incidence rate of 39 (95% CI: 36 to 42) per 1,000 patient-years. The subsequent risk of all trial outcomes was elevated after the occurrence of pneumonia. In PARADIGM-HF, the adjusted hazard ratio (HR) for the risk of death from any cause was 4.34 (95% CI: 3.73 to 5.05). The corresponding adjusted HR in PARAGON-HF was 3.76 (95% CI: 3.09 to 4.58).

CONCLUSIONS:

The incidence of pneumonia was high in patients with HF, especially HFpEF, at around 3 times the expected rate. A first episode of pneumonia was associated with 4-fold higher mortality. (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF], NCT01035255; Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] With ARB [Angiotensin Receptor Blocker] Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF], NCT01920711).

• Authors: Li Shen, Pardeep S Jhund, Inder S Anand, Ankeet S Bhatt, Akshay S Desai, Aldo P Maggioni, Felipe A Martinez, Marc A Pfeffer, Adel R Rizkala, Jean L Rouleau, Karl Swedberg, Muthiah Vaduganathan, Orly Vardeny, Dirk J van Veldhuisen, Faiez Zannad, Michael R Zile, Milton Packer, Scott D Solomon, John J V McMurray
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 77 Issue 16 Pg. 1961-1973 (04 27 2021) ISSN: 1558-3597 [Electronic] United States
• PMID: 33888245 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Neprilysin

Topics

• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists (administration & dosage)
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage)
• Double-Blind Method
• Female
• Follow-Up Studies
• Heart Failure (diagnosis, drug therapy, epidemiology)
• Humans
• Incidence
• Male
• Middle Aged
• Neprilysin (administration & dosage)
• Pneumonia (diagnosis, drug therapy, epidemiology)
• Prospective Studies
• Retrospective Studies
• Survival Rate
• Treatment Outcome