Clinical InvestigationHeart FailureIntermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults
Section snippets
Study population and data collection
The Cardiovascular Health Study (CHS) enrolled 5,888 community-dwelling elderly adults (age ≥65 years) from 4 US communities in California, Philadelphia, North Carolina, and Maryland.10 The baseline evaluation (1989-1994) included a standardized physical examination, diagnostic and laboratory evaluation, and questionnaires on health status, medical history, lifestyle habits, and cardiovascular risk factors.10, 11, 12 Update of major examination components and surveillance of new cardiovascular
Results
Of 5,888 participants in CHS, 275 had clinical diagnosis HF at enrollment and were excluded. Our analysis included 5,613 participants. During follow-up, 1,315 (23.4%) participants were hospitalized with pneumonia at least once (median time to pneumonia 8.8 years, IQR 5.3-12.5 years), whereas 1,868 participants developed new-onset HF (median time to new-onset HF 9.0 years, IQR 4.8-13.6 years). Participants who were hospitalized with pneumonia were slightly younger than the rest of participants
Discussion
In a large community-based prospective sample of elderly adults without HF at baseline, hospitalization for pneumonia was independently associated with a pronounced increase in the risk of new-onset HF in the intermediate and long term. This association was evident for patients with both severe and nonsevere pneumonia. Our results did not substantially change even when stringent case definitions for pneumonia were used or under extreme assumptions for potential informative censoring. The
Conclusion
In this large community-based sample of elderly adults, hospitalization for pneumonia was associated with subsequent increase in the risk of new-onset HF in the intermediate and long term postinfection. Future studies are needed to clearly elucidate the mechanisms of this association in order to design targeted preventive strategies.
Disclaimer
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Role of investigators
V.F.C.-M., M.T., S.Y., R.K., G.D., M.S.V.E., and J.A.C. designed the study; the data were gathered by R.K., A.B.N., and M.F.L.; M.T. performed the statistical analyses; V.F.C.-M., M.T., and J.A.C. vouch for the data and analysis; all authors provided critical input to the interpretations of the results; V.F.C.-M. wrote the first manuscript draft; all authors approved the final version. The authors had full access to data and full control of the decision to publish.
Disclosures
CHS was supported by contracts HHSN268201200036C, HHSN268200800007C, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086 and Grant HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by AG023629 from the National Institute on Aging. A full list of principal CHS investigators and institutions can be found at CHS-NHLB.org. Dr
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Cited by (52)
Association between pneumonia hospitalisation and long-term risk of cardiovascular disease in Chinese adults: A prospective cohort study
2023, eClinicalMedicineCitation Excerpt :Two prospective cohort studies have consistently found that pneumonia was associated with an increased risk of HF. The CHS study of 5613 adults aged ≥65 years, with a mean follow-up of 11.9 years, showed a gradual decrease in the elevated HF risk after pneumonia hospitalisation but remained at the time interval of 5+ years (HR = 2.0; 95% CI: 1.56–2.58).9 A Canadian cohort study included 4988 pneumonia cases and 23,060 matched controls, with a median follow-up of 9.9 years.10
Infection and arterial stiffness
2022, Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and DiseasePersistent Lung Inflammation After Clinical Resolution of Community-Acquired Pneumonia as Measured by <sup>18</sup>FDG-PET/CT Imaging
2021, ChestCitation Excerpt :The risk of these outcomes also increases after CAP and remains elevated for months after resolution of the infection.1-5 Our novel finding of lingering foci of inflammatory activity in the lung parenchyma of CAP survivors provides a plausible mechanism for this increased morbidity and mortality post-CAP and its contribution to this phenomenon needs to be further investigated in experimental and clinical studies.1-5 Such investigations, along with the elucidation of the biological pathways driving post-CAP lung inflammation, could then inform therapeutic interventions targeting this phenomenon to improve post-CAP outcomes.
Community-Acquired Pneumonia
2021, Encyclopedia of Respiratory Medicine, Second Edition