• Reimar W Thomsen, Nongyao Kasatpibal, Anders Riis, Mette Nørgaard, and Henrik T Sørensen.
• Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark. r.thomsen@rn.dk
• J Gen Intern Med. 2008 Sep 1; 23 (9): 140714131407-13.

BackgroundThere are limited data describing how pre-existing heart failure affects mortality following pneumonia.ObjectiveTo examine the association between history and severity of heart failure and mortality among patients hospitalized for pneumonia.DesignPopulation-based cohort study in Western Denmark between 1994 and 2003.Patients33,736 adults with a first-time hospitalization for pneumonia. Heart failure was identified and categorized based on data linked from population-based health care databases.MeasurementsWe compared 30-day mortality between patients with pre-existing heart failure and other pneumonia patients, while adjusting for age, gender, comorbidity, and medication use.ResultsThe 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.ConclusionHistory and severity of heart failure are associated with a poor outcome for patients hospitalized with pneumonia.

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