Hospital-Acquired Pneumonia Possibly Linked to Worse Outcomes Among Patients With Acute Heart Failure

Prevention and early screening efforts need to be stepped up for patients with acute heart failure (AHF) who develop hospital-acquired pneumonia (HAP) for their condition, due to clinical outcomes that include an increase in all-cause death both during and after their hospital stay and worsening heart failure, reported study results in Journal of Clinical Medicine.

The authors conducted their study because they believed there needs to be a better understanding of how HAP affects patients with AHF. They defined HAP using clinical practice guidelines from the Infectious Diseases Society of America and the American Thoracic Society (abnormal x-ray and 2 of the following: fever >38°C, abnormal white blood cell count, purulent secretions) and retrospectively analyzed data from January 2013 to May 2016 from the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure registry, located in Suita, Japan.

There were 3 primary outcomes among their 776 consecutive hospitalized patients:

• In-hospital all-cause death
• In-hospital worsening heart failure
• Postdischarge all-cause death

Compared with those without HAP (n = 717; mean [SD] age, 75 [12] years), the results demonstrate significant associations with worse outcomes in in-hospital death (12% vs 1%; P < .001), worsening heart failure (28% vs 7%; P < .001), and longer hospital stay (P = .003) for patients with HAP (n = 59; mean age, 79 [9] years).

Similar results were seen among those who were discharged (median [IQR] follow-up, 741 [IQR, 422-1000] days) in that patients with AHF and HAP had a significantly higher incidence of all cause-death than those without HAP (P < .001). Twenty percent of these patients died following discharge.

Multivariable Cox regression also showed a link between HAP and all-cause death post discharge (HR, 1.86; 95% CI, 1.08-3.19).

The additional measures of higher serum white blood cell count (odds ratio [OR], 1.18; 95% CI, 1.09-1.29) and serum C-reactive protein (OR, 1.08; 95% CI, 1.01-1.06) both shared independent associations with HAP, too, as did being of older age (OR, 1.04; 95% CI, 1.01-1.08) and male (OR, 2.21; 95% CI, 1.14-4.28). These patients also had a significantly higher rate of cardiovascular intensive care unit admission, greater use of loop diuretics, and lower serum albumin levels.

“These findings indicate the importance of HAP development for further risk stratification in hospitalized patients with AHF,” the authors conclude. “Generally, mechanical ventilation performed for more than 48 hours, residence in an [intensive care unit], length of hospital stay, underlying illness severity, and presence of comorbidities are considered major risk factors for HAP.”

They recommend early screening for dysphagia, which has reduced the incidence of pneumonia following a stroke, as well as evaluating patients’ ability to swallow during early screenings for HAP and helping them with related rehabilitation, especially for patients with a history of frailty or cerebral infarctions. Larger studies are also called for due to the small sample size and that this was a single-center study, which restricts the generalizability of the findings.

Reference

Tada A, Omote K, Nagai T, et al. Prevalence, determinants, and prognostic significance of hospital acquired pneumonia in patients with acute heart failure. J Clin Med. 2020;9(7):E2219. doi:10.3390/jcm9072219