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The Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study

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Abstract

Background

There are limited data describing how pre-existing heart failure affects mortality following pneumonia.

Objective

To examine the association between history and severity of heart failure and mortality among patients hospitalized for pneumonia.

Design

Population-based cohort study in Western Denmark between 1994 and 2003.

Patients

33,736 adults with a first-time hospitalization for pneumonia. Heart failure was identified and categorized based on data linked from population-based health care databases.

Measurements

We compared 30-day mortality between patients with pre-existing heart failure and other pneumonia patients, while adjusting for age, gender, comorbidity, and medication use.

Results

The 30-day mortality was 24.4% among heart-failure patients and 14.4% among other patients, with an adjusted 30-day mortality rate ratio (MRR) of 1.40 (95% CI: 1.29–1.51). Adjusted MRRs increased according to severity of pre-existing heart failure, as indicated by medication regimen: thiazide-based, MRR = 1.09 (95% CI: 0.79–1.50); loop-diuretics, MRR = 1.25 (95% CI: 1.10–1.43); loop-diuretics and digoxin, MRR = 1.35 (95% CI: 1.18–1.55); loop-diuretics and spironolactone, MRR = 1.72 (95% CI: 1.49–2.00). Pre-existing heart valve disease and atrial fibrillation substantially increased mortality.

Conclusion

History and severity of heart failure are associated with a poor outcome for patients hospitalized with pneumonia.

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Acknowledgements

This study received financial support from the Western Danish Research Forum for Health Sciences, and from the “Klinisk Epidemiologisk Forskningsfond”, Denmark.

Conflict of interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark

    Reimar W. Thomsen MD, PhD, Nongyao Kasatpibal RN, MNS, PhD, Anders Riis MSc, Mette Nørgaard MD, PhD & Henrik T. Sørensen MD, DMSc

  2. Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand

    Nongyao Kasatpibal RN, MNS, PhD

  3. Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA

    Henrik T. Sørensen MD, DMSc

Authors
  1. Reimar W. Thomsen MD, PhD
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  2. Nongyao Kasatpibal RN, MNS, PhD
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  3. Anders Riis MSc
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  4. Mette Nørgaard MD, PhD
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  5. Henrik T. Sørensen MD, DMSc
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Corresponding author

Correspondence to Reimar W. Thomsen MD, PhD.

Appendix

Appendix

World Health Organization International Classification of Diseases ICD-8 and ICD-10 codes and Anatomical Therapeutical Chemical classification system (ATC) codes used in this study.

Pneumonia

ICD-10: J12-J18, A481, and A709.

Heart failure

ICD-8: 427.09, 427.10, 427.11, 427.19, 428.99, 782.49, 425.99; ICD-10: I50, I11.0, I13.0, I13.2, I42.0, I42.6, I42.7, I42.8, I42.9, I25.5

Diabetes

ICD-8: 249, 250; ICD-10: E10, E11; ATC codes A10A, A10B

Heart failure-related conditions:

Myocardial infarction

ICD-8: 410; ICD-10: I21, I22, I23

Atrial fibrillation

ICD-8: 427.93, 427.94; ICD-10: I48

Heart valve disease

ICD-8: 394, 395, 396, 397, 398, 424; ICD-10: I34, I35, I05, I06, I07, I08, I091, I098, I099, I36, I37, I38, I39

Cardiomyopathy

ICD-8: 425; ICD-10: I42

Alcoholism-related disorders

ICD-8: 291, 303, 979, 980, 577.10; ICD-10: F10, K86.0, Z72.1, R78.0, T51

Heart failure drugs

ATC codes: B01AA, C01AA, C01CA08-C01CA14, C03A, C03C, C07AB, C02E, C02L, C09A, C09B, C08DA51, C09C, C03DA01.

Systemic antibiotics

ATC code: J01.

Immunosuppressive drugs

ATC codes: L01, L04, and H02AB.

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Thomsen, R.W., Kasatpibal, N., Riis, A. et al. The Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study. J GEN INTERN MED 23, 1407–1413 (2008). https://doi.org/10.1007/s11606-008-0672-3

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  • DOI: https://doi.org/10.1007/s11606-008-0672-3

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