Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. CAP can trigger acute cardiac events. We sought to determine the incidence of major cardiac complications in CAP patients to characterize the magnitude of this problem. Two investigators searched MEDLINE, Scopus, and EMBASE for observational studies of immunocompetent adults with clinical and radiological evidence of CAP that reported any of the following: overall cardiac complications, incident heart failure, acute coronary syndromes (ACS), or incident cardiac arrhythmias occurring within 30 days of CAP diagnosis. At a minimum, studies had to establish enrolment procedures and inclusion and exclusion criteria, enroll their patients sequentially, and report the incidence of cardiac complications as a function of their entire cohorts. Studies with focus on nosocomial or health care-associated pneumonia were not included. Review of 2,176 citations yielded 25 articles that met eligibility and minimum quality criteria. Seventeen articles (68%) reported cohorts of CAP inpatients. In this group, the pooled incidence rates for overall cardiac complications (six cohorts, 2,119 patients), incident heart failure (eight cohorts, 4,215 patients), acute coronary syndromes (six cohorts, 2,657 patients), and incident cardiac arrhythmias (six cohorts, 2,596 patients), were 17.7% (confidence interval [CI] 13.9-22.2), 14.1% (9.3-20.6), 5.3% (3.2-8.6), and 4.7% (2.4-8.9), respectively. One article reported cardiac complications in CAP outpatients, four in low-risk (not severely ill) inpatients, and three in high-risk inpatients. The incidences for all outcomes except overall cardiac complications were lower in the two former groups and higher in the latter. One additional study reported on CAP outpatients and low-risk inpatients without discriminating between these groups. Twelve studies (48%) asserted the evaluation of cardiac complications in their methods but only six (24%) provided a definition for them. Only three studies, all examining ACS, carried out risk factor analysis for these events. No study analyzed the association between cardiac complications and other medical complications or their impact on other CAP outcomes. Major cardiac complications occur in a substantial proportion of patients with CAP. Physicians and patients need to appreciate the significance of this association for timely recognition and management of these events. Strategies aimed at preventing pneumonia (i.e., influenza and pneumococcal vaccination) in high-risk populations need to be optimized. Further research is needed to understand the mechanisms underlying this association, measure the impact of cardiac complications on other CAP outcomes, identify those patients with CAP at high risk of developing cardiac complications, and design strategies to prevent their occurrence in this population.
Highlights
Community-acquired pneumonia (CAP) is a common and deadly condition
Major cardiac complications occur in a substantial proportion of patients with CAP
Strategies aimed at preventing pneumonia in high-risk populations need to be optimized
Summary
Community-acquired pneumonia (CAP) is a common and deadly condition. In the United States alone, it is estimated that each year CAP affects 5–6 million people, results in about 1.1 million hospital admissions, and causes the death of over 60,000 Americans, representing the most frequent cause of infectious disease–related mortality and, along with influenza, the overall eighth leading cause of death in this country [1,2].CAP occurs more frequently in the middle aged and the elderly, a population that is at the highest risk for cardiac diseases [3,4]. The researchers used strict criteria to select appropriate articles (such as radiographic evidence of CAP) and only selected studies that had outcomes of the incidence of cardiac complications, such as incident (new or worsening) heart failure, acute coronary syndromes (acute myocardial infarction or unstable angina), and incident cardiac arrhythmias within 30 days of diagnosis of CAP. Using these methods, the researchers identified 2,176 articles for review and selected 25 eligible papers for their analysis. No study analyzed the association between cardiac complications and other medical complications (such as acute renal failure, respiratory failure, shock, etc.) or their impact on other outcomes, such as death, in patients with CAP
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