Intended for healthcare professionals

CCBYNC Open access

Risk of heart failure after community acquired pneumonia: prospective controlled study with 10 years of follow-up

BMJ 2017; 356 doi: (Published 13 February 2017) Cite this as: BMJ 2017;356:j413
  1. Dean T Eurich, professor1 2,
  2. Thomas J Marrie, professor3,
  3. Jasjeet K Minhas-Sandhu, research associate2,
  4. Sumit R Majumdar, professor1 2 4
  1. 1School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  2. 2ACHORD, 2-040 Li Ka Shing Center, University of Alberta, Edmonton, Alberta, Canada, T6G 2E1
  3. 3Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  4. 4Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to: D T Eurich deurich{at}
  • Accepted 11 January 2017


Objective To determine the attributable risk of community acquired pneumonia on incidence of heart failure throughout the age range of affected patients and severity of the infection.

Design Cohort study.

Setting Six hospitals and seven emergency departments in Edmonton, Alberta, Canada, 2000-02.

Participants 4988 adults with community acquired pneumonia and no history of heart failure were prospectively recruited and matched on age, sex, and setting of treatment (inpatient or outpatient) with up to five adults without pneumonia (controls) or prevalent heart failure (n=23 060).

Main outcome measures Risk of hospital admission for incident heart failure or a combined endpoint of heart failure or death up to 2012, evaluated using multivariable Cox proportional hazards analyses.

Results The average age of participants was 55 years, 2649 (53.1%) were men, and 63.4% were managed as outpatients. Over a median of 9.9 years (interquartile range 5.9-10.6), 11.9% (n=592) of patients with pneumonia had incident heart failure compared with 7.4% (n=1712) of controls (adjusted hazard ratio 1.61, 95% confidence interval 1.44 to 1.81). Patients with pneumonia aged 65 or less had the lowest absolute increase (but greatest relative risk) of heart failure compared with controls (4.8% v 2.2%; adjusted hazard ratio 1.98, 95% confidence interval 1.5 to 2.53), whereas patients with pneumonia aged more than 65 years had the highest absolute increase (but lowest relative risk) of heart failure (24.8% v 18.9%; adjusted hazard ratio 1.55, 1.36 to 1.77). Results were consistent in the short term (90 days) and intermediate term (one year) and whether patients were treated in hospital or as outpatients.

Conclusion Our results show that community acquired pneumonia substantially increases the risk of heart failure across the age and severity range of cases. This should be considered when formulating post-discharge care plans and preventive strategies, and assessing downstream episodes of dyspnoea.


  • Contributors: DTE and JMS were responsible for the study design, statistical analysis, interpretation of data, and drafting the manuscript. All authors contributed to the study design, interpretation of data, and critical revision of the manuscript. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. DTE is the guarantor.

  • Funding: DTE receives salary support through a Canada Research Chair Award from the Government of Canada. SRM holds the Endowed Chair in Patient Health Management from the Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta. TJM has received grants-in-aid from Capital Health, and unrestricted grants from Abbott Canada, Pfizer Canada, and Janssen-Ortho Canada.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the health research ethics board at the University of Alberta.

  • Data sharing: No additional data available.

  • Transparency: The lead author (DTE) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text