Filippo Pieralli1, Vieri Vannucchi2, Carlo Nozzoli1, Giuseppe Augello3, Francesco Dentali4, Giulia De Marzi1, Generoso Uomo5, Filippo Risaliti6, Laura Morbidoni7, Antonino Mazzone8, Claudio Santini9, Daniela Tirotta10, Francesco Corradi11, Riccardo Gerloni12, Paola Gnerre13, Gualberto Gussoni14, Antonella Valerio15, Mauro Campanini16, Dario Manfellotto17, Andrea Fontanella18. 1. Intermediate Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 2. Internal Medicine, Hospital "Santa Maria Nuova" Florence, Florence, Italy. 3. Internal Medicine, P.O. "Barone Lombardo", Canicattì, AG, Italy. 4. Internal Medicine, Hospital of Luino, ASST-Sette Laghi, and University of Insubria, Varese, Italy. 5. Medical Department, Internal Medicine, Hospital "Cardarelli", Naples, Italy. 6. Internal Medicine, Hospital of Prato, Prato, Italy. 7. Internal Medicine, Hospital "Civile" of Senigallia, Ancona, Italy. 8. Medical Department, Internal Medicine, Hospital "Civile" of Legnano, Milan, Italy. 9. Medical Department, Internal Medicine, Hospital "Vannini", Rome, Italy. 10. Internal Medicine, Hospital of Cattolica, Rimini, Italy. 11. Medical Department, Internal Medicine 2, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 12. Internal Medicine, "Ospedali Riuniti di Trieste", Trieste, Italy. 13. Internal Medicine, "San Paolo" Hospital, Savona, Italy. 14. Research Department, FADOI Foundation, Piazzale Cadorna, 15, 20123, Milan, Italy. 15. Research Department, FADOI Foundation, Piazzale Cadorna, 15, 20123, Milan, Italy. antonella.valerio@fadoi.org. 16. Department of Internal Medicine, Hospital "Maggiore della Carità", Novara, Italy. 17. Department of Internal Medicine, Ospedale Fatebenefratelli-AFaR, Isola Tiberina, Rome, Italy. 18. Medical Department, Hospital "Buon Consiglio-Fatebenefratelli", Naples, Italy.
Abstract
BACKGROUND: The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). METHODS: This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. RESULTS: A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14-2.51; p = 0.009). CONCLUSION: Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. TRIAL REGISTRATION: NCT03798457 Registered 10 January 2019 - Retrospectively registered.
BACKGROUND: The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). METHODS: This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. RESULTS: A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14-2.51; p = 0.009). CONCLUSION: Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. TRIAL REGISTRATION: NCT03798457 Registered 10 January 2019 - Retrospectively registered.
Authors: W S Lim; S V Baudouin; R C George; A T Hill; C Jamieson; I Le Jeune; J T Macfarlane; R C Read; H J Roberts; M L Levy; M Wani; M A Woodhead Journal: Thorax Date: 2009-10 Impact factor: 9.139