Factors May Predict Cardiac Events in Some Pneumonia Inpatients

Certain hospitalized adult patients with community-acquired pneumonia (CAP) may require closer monitoring and perhaps intervention because they are at increased risk for acute cardiac events, research suggests.

Eight percent of patients in a prospective cohort study of 3,921 such patients had an acute cardiac event, investigators found. A history of heart disease, hypoalbuminemia, older age, and several other factors conferred an increase in the odds of such events, and a prediction score incorporating these factors had an area under the receiver operating characteristic curve of 0.74.

It may be possible to apply this new information to improve patient outcomes, according to Dr. Carolina Garcia-Vidal, of Bellvitge University Hospital in Barcelona, who presented her research team’s data at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

"The first thing is you have to recognize which patients are at high risk. And then in that population, maybe you have to do some extra things," she explained in an interview. "Maybe you have to follow [the patient] closer, maybe you have to follow in a special way, such as with a cardiac monitor."

Increased cardiac stress, hypoxemia, and inflammation may all contribute to cardiac events in patients with CAP, Dr. Garcia-Vidal noted. Regarding the last, "if you are able to relate these events with a proinflammatory effect, maybe you can do something to modulate this inflammatory [state]. I think that’s the future."

The investigators prospectively studied 3,921 adult inpatients treated in the hospital between 1995 and 2010 who had CAP and did not have severe immunosuppression.

Overall, 8% experienced at least one acute cardiac event (myocardial infarction, new or worsening arrhythmia, and/or new or worsening congestive heart failure) during their hospital stay, according to results reported in a poster session at the conference, which was sponsored by the American Society for Microbiology.

"These patients have a mortality that is very high," Dr. Garcia-Vidal pointed out. In fact, they were about three times more likely to die within 30 days than their event-free counterparts (19% vs. 6%).

In a multivariate analysis, patients had significantly higher odds of acute cardiac events if they were older than 65 years or had heart disease, kidney disease, tachycardia, hypotension, hypoalbuminemia, multilobar pneumonia, or pneumococcal pneumonia, with odds ratios ranging from 1.37 to 3.03.

The factors were combined to create a 9-point score, which had an area under the receiver operating characteristic curve of 0.74 for predicting acute cardiac events. The rate of such events was 19% among patients falling into a high-risk group, defined as having a score of 3 or higher.

The investigators plan to validate the model in another patient population, according to Dr. Garcia-Vidal, whose team reported having no relevant conflicts of interest.

Certain hospitalized adult patients with community-acquired pneumonia (CAP) may require closer monitoring and perhaps intervention because they are at increased risk for acute cardiac events, research suggests.

Eight percent of patients in a prospective cohort study of 3,921 such patients had an acute cardiac event, investigators found. A history of heart disease, hypoalbuminemia, older age, and several other factors conferred an increase in the odds of such events, and a prediction score incorporating these factors had an area under the receiver operating characteristic curve of 0.74.

It may be possible to apply this new information to improve patient outcomes, according to Dr. Carolina Garcia-Vidal, of Bellvitge University Hospital in Barcelona, who presented her research team’s data at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

"The first thing is you have to recognize which patients are at high risk. And then in that population, maybe you have to do some extra things," she explained in an interview. "Maybe you have to follow [the patient] closer, maybe you have to follow in a special way, such as with a cardiac monitor."

Increased cardiac stress, hypoxemia, and inflammation may all contribute to cardiac events in patients with CAP, Dr. Garcia-Vidal noted. Regarding the last, "if you are able to relate these events with a proinflammatory effect, maybe you can do something to modulate this inflammatory [state]. I think that’s the future."

The investigators prospectively studied 3,921 adult inpatients treated in the hospital between 1995 and 2010 who had CAP and did not have severe immunosuppression.

Overall, 8% experienced at least one acute cardiac event (myocardial infarction, new or worsening arrhythmia, and/or new or worsening congestive heart failure) during their hospital stay, according to results reported in a poster session at the conference, which was sponsored by the American Society for Microbiology.

"These patients have a mortality that is very high," Dr. Garcia-Vidal pointed out. In fact, they were about three times more likely to die within 30 days than their event-free counterparts (19% vs. 6%).

In a multivariate analysis, patients had significantly higher odds of acute cardiac events if they were older than 65 years or had heart disease, kidney disease, tachycardia, hypotension, hypoalbuminemia, multilobar pneumonia, or pneumococcal pneumonia, with odds ratios ranging from 1.37 to 3.03.

The factors were combined to create a 9-point score, which had an area under the receiver operating characteristic curve of 0.74 for predicting acute cardiac events. The rate of such events was 19% among patients falling into a high-risk group, defined as having a score of 3 or higher.

The investigators plan to validate the model in another patient population, according to Dr. Garcia-Vidal, whose team reported having no relevant conflicts of interest.

Certain hospitalized adult patients with community-acquired pneumonia (CAP) may require closer monitoring and perhaps intervention because they are at increased risk for acute cardiac events, research suggests.

Eight percent of patients in a prospective cohort study of 3,921 such patients had an acute cardiac event, investigators found. A history of heart disease, hypoalbuminemia, older age, and several other factors conferred an increase in the odds of such events, and a prediction score incorporating these factors had an area under the receiver operating characteristic curve of 0.74.

It may be possible to apply this new information to improve patient outcomes, according to Dr. Carolina Garcia-Vidal, of Bellvitge University Hospital in Barcelona, who presented her research team’s data at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

"The first thing is you have to recognize which patients are at high risk. And then in that population, maybe you have to do some extra things," she explained in an interview. "Maybe you have to follow [the patient] closer, maybe you have to follow in a special way, such as with a cardiac monitor."

Increased cardiac stress, hypoxemia, and inflammation may all contribute to cardiac events in patients with CAP, Dr. Garcia-Vidal noted. Regarding the last, "if you are able to relate these events with a proinflammatory effect, maybe you can do something to modulate this inflammatory [state]. I think that’s the future."

The investigators prospectively studied 3,921 adult inpatients treated in the hospital between 1995 and 2010 who had CAP and did not have severe immunosuppression.

Overall, 8% experienced at least one acute cardiac event (myocardial infarction, new or worsening arrhythmia, and/or new or worsening congestive heart failure) during their hospital stay, according to results reported in a poster session at the conference, which was sponsored by the American Society for Microbiology.

"These patients have a mortality that is very high," Dr. Garcia-Vidal pointed out. In fact, they were about three times more likely to die within 30 days than their event-free counterparts (19% vs. 6%).

In a multivariate analysis, patients had significantly higher odds of acute cardiac events if they were older than 65 years or had heart disease, kidney disease, tachycardia, hypotension, hypoalbuminemia, multilobar pneumonia, or pneumococcal pneumonia, with odds ratios ranging from 1.37 to 3.03.

The factors were combined to create a 9-point score, which had an area under the receiver operating characteristic curve of 0.74 for predicting acute cardiac events. The rate of such events was 19% among patients falling into a high-risk group, defined as having a score of 3 or higher.

The investigators plan to validate the model in another patient population, according to Dr. Garcia-Vidal, whose team reported having no relevant conflicts of interest.