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Randomized Controlled Trial
. 2021 Apr 27;77(16):1961-1973.
doi: 10.1016/j.jacc.2021.03.001.

Incidence and Outcomes of Pneumonia in Patients With Heart Failure

Li Shen  1 , Pardeep S Jhund  2 , Inder S Anand  3 , Ankeet S Bhatt  4 , Akshay S Desai  4 , Aldo P Maggioni  5 , Felipe A Martinez  6 , Marc A Pfeffer  4 , Adel R Rizkala  7 , Jean L Rouleau  8 , Karl Swedberg  9 , Muthiah Vaduganathan  4 , Orly Vardeny  10 , Dirk J van Veldhuisen  11 , Faiez Zannad  12 , Michael R Zile  13 , Milton Packer  14 , Scott D Solomon  4 , John J V McMurray  15
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Free article
Randomized Controlled Trial

Incidence and Outcomes of Pneumonia in Patients With Heart Failure

Li Shen et al. J Am Coll Cardiol. .
Free article

Abstract

Background: The incidence of pneumonia and subsequent outcomes has not been compared in patients with heart failure and reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).

Objectives: This study aimed to examine the rate and impact of pneumonia in the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in Heart Failure with Preserved Ejection Fraction) trials.

Methods: The authors analyzed the incidence of investigator-reported pneumonia and the rates of HF hospitalization, cardiovascular death, and all-cause death before and after the occurrence of pneumonia, and estimated risk after the first occurrence of pneumonia in unadjusted and adjusted analyses (the latter including N-terminal pro-B-type natriuretic peptide).

Results: In PARADIGM-HF, 528 patients (6.3%) developed pneumonia after randomization, giving an incidence rate of 29 (95% CI: 27 to 32) per 1,000 patient-years. In PARAGON-HF, 510 patients (10.6%) developed pneumonia, giving an incidence rate of 39 (95% CI: 36 to 42) per 1,000 patient-years. The subsequent risk of all trial outcomes was elevated after the occurrence of pneumonia. In PARADIGM-HF, the adjusted hazard ratio (HR) for the risk of death from any cause was 4.34 (95% CI: 3.73 to 5.05). The corresponding adjusted HR in PARAGON-HF was 3.76 (95% CI: 3.09 to 4.58).

Conclusions: The incidence of pneumonia was high in patients with HF, especially HFpEF, at around 3 times the expected rate. A first episode of pneumonia was associated with 4-fold higher mortality. (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF], NCT01035255; Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] With ARB [Angiotensin Receptor Blocker] Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF], NCT01920711).

Keywords: heart failure; incidence; pneumonia; risk; vaccination.

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Conflict of interest statement

Funding Support and Author Disclosures The PARADIGM-HF and PARAGON-HF trials were funded by Novartis. Dr. McMurray is supported by a British Heart Foundation Centre of Research Excellence Grant (RE/18/6/34217). Drs Jhund, Anand, Bhatt, Desai, Maggioni, Martinez, Pfeffer, Rizkala, Rouleau, Swedberg, Vaduganathan, Vardeny, van Veldhuisen, Zannad, Zile, Packer, Solomon, and McMurray or their institutions have received funding from Novartis.

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