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Incidence and Outcomes of Pneumonia in Patients With Heart Failure

Li Shen 1, 2 Pardeep S Jhund 2 Inder S Anand 3, 4 Ankeet S Bhatt 5 Akshay S Desai 5 Aldo P Maggioni 6 Felipe A Martinez 7 Marc A Pfeffer 5 Adel R Rizkala 8 Jean L Rouleau 9 Karl Swedberg 10 Muthiah Vaduganathan 5 Orly Vardeny 4, 11 Dirk J van Veldhuisen 12 Faiez Zannad 13, 14, 15, 16 Michael R Zile 17, 18 Milton Packer 19 Scott D Solomon 5 John J V Mcmurray 2 
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).
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https://hal.univ-lorraine.fr/hal-03236565
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Submitted on : Wednesday, May 26, 2021 - 12:11:48 PM
Last modification on : Monday, August 29, 2022 - 10:14:36 AM
Long-term archiving on: : Friday, August 27, 2021 - 7:18:16 PM

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Distributed under a Creative Commons Attribution - NonCommercial - NoDerivatives 4.0 International License

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Li Shen, Pardeep S Jhund, Inder S Anand, Ankeet S Bhatt, Akshay S Desai, et al.. Incidence and Outcomes of Pneumonia in Patients With Heart Failure. Journal of the American College of Cardiology, 2021, 77 (16), pp.1961-1973. ⟨10.1016/j.jacc.2021.03.001⟩. ⟨hal-03236565⟩

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