Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

Filippo Pieralli, Vieri Vannucchi, Carlo Nozzoli, Giuseppe Augello, Francesco Dentali, Giulia De Marzi, Generoso Uomo, Filippo Risaliti, Laura Morbidoni, Antonino Mazzone, Claudio Santini, Daniela Tirotta, Francesco Corradi, Riccardo Gerloni, Paola Gnerre, Gualberto Gussoni, Antonella Valerio, Mauro Campanini, Dario Manfellotto, Andrea Fontanella, FADOI-ICECAP Study Group, T Attardo, G Augello, F Dentali, L Tavecchia, V Gessi, F Pieralli, G De Marzi, A Torrigiani, L Corbo, G Uomo, F Gallucci, C Mastrobuoni, F Risaliti, A Giani, L Morbidoni, Consalvo Teodora, A Mazzone, E Ricchiuti, C Santini, A Rosato, D Tirotta, L Giampaolo, F Corradi, A Torrigiani, S Di Gregorio, R Gerloni, L Parodi, P Gnerre, V Vannucchi, F Pallini, G Landini, P Giuri, G Prampolini, D Arioli, M C Leone, C Canale, F Condemi, R Lupica, F Manzola, R Mascianà, G Agnelli, C Becattini, E D'Agostini, M G Mosconi, G Bogliari, A Rossi, M Campanini, G Iannantuoni, L Bartolino, A Montagnani, V Verdiani, M Gambacorta, S Lenti, S Francioni, M Giorgi-Pierfranceschi, C Cattabiani, F Orlandini, L Scuotri, M La Regina, F Corsini, L Anastasio, N Mumoli, V Mazzi, A Camaiti, G Balbi, F Ragazzo, M Pengo, Filippo Pieralli, Vieri Vannucchi, Carlo Nozzoli, Giuseppe Augello, Francesco Dentali, Giulia De Marzi, Generoso Uomo, Filippo Risaliti, Laura Morbidoni, Antonino Mazzone, Claudio Santini, Daniela Tirotta, Francesco Corradi, Riccardo Gerloni, Paola Gnerre, Gualberto Gussoni, Antonella Valerio, Mauro Campanini, Dario Manfellotto, Andrea Fontanella, FADOI-ICECAP Study Group, T Attardo, G Augello, F Dentali, L Tavecchia, V Gessi, F Pieralli, G De Marzi, A Torrigiani, L Corbo, G Uomo, F Gallucci, C Mastrobuoni, F Risaliti, A Giani, L Morbidoni, Consalvo Teodora, A Mazzone, E Ricchiuti, C Santini, A Rosato, D Tirotta, L Giampaolo, F Corradi, A Torrigiani, S Di Gregorio, R Gerloni, L Parodi, P Gnerre, V Vannucchi, F Pallini, G Landini, P Giuri, G Prampolini, D Arioli, M C Leone, C Canale, F Condemi, R Lupica, F Manzola, R Mascianà, G Agnelli, C Becattini, E D'Agostini, M G Mosconi, G Bogliari, A Rossi, M Campanini, G Iannantuoni, L Bartolino, A Montagnani, V Verdiani, M Gambacorta, S Lenti, S Francioni, M Giorgi-Pierfranceschi, C Cattabiani, F Orlandini, L Scuotri, M La Regina, F Corsini, L Anastasio, N Mumoli, V Mazzi, A Camaiti, G Balbi, F Ragazzo, M Pengo

Abstract

Background: The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs).

Methods: This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation.

Results: A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14-2.51; p = 0.009).

Conclusion: Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile.

Trial registration: NCT03798457 Registered 10 January 2019 - Retrospectively registered.

Keywords: Cardiovascular events; Community-acquired pneumonia.

Conflict of interest statement

All the authors: Filippo Pieralli, Vieri Vannucchi, Carlo Nozzoli, Giuseppe Augello, Francesco Dentali, Giulia De Marzi, Generoso Uomo, Filippo Risaliti, Laura Morbidoni, Antonino Mazzone, Claudio Santini, Daniela Tirotta, Francesco Corradi, Riccardo Gerloni, Paola Gnerre, Gualberto Gussoni, Antonella Valerio, Mauro Campanini, Dario Manfellotto, and Andrea Fontanella have declared no competing interests concerning the submitted manuscript.

Figures

Fig. 1
Fig. 1
Patients’ disposition in the study
Fig. 2
Fig. 2
Distribution and type of cardiovascular events over time since hospital admission for CAP
Fig. 3
Fig. 3
Estimated risk of 30-day mortality by Cox proportional hazard model of CAP patients according to the presence or absence of CV events during hospitalisation

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