Risk factors and lifelong impact of community-acquired pneumonia in congenital heart disease. Evers PD, Farkas DK, Khoury M, Olsen M, Madsen NL. Cardiol Young. 2020 Dec 9:1-6. doi: 10.1017/S1047951120004254. PMID: 33292879
Take Home Points:
- In pneumonia hospitalization. mortality was elevated above the comparison population with a 30-day mortality rate ratio of 1.31 (95% confidence interval: 1.00–1.73). Adults with CHD are at elevated risk of pneumonia hospitalizations and pneumonia-associated mortality. This risk is further elevated in those with severe CHD and extracardiac defects.
- The cumulative incidence of pneumonia hospitalization was higher for adults with CHD (hazard ratio 1.90; 95% confidence interval: 1.74–2.06) than the comparison cohort.
- CHD individuals with severe/univentricular subtypes demonstrate a heightened risk compared to the non-CHD cohort (hazard ratio: 2.35; 95% confidence interval: 1.94–2.84), as well as compared to those with mild/moderate CHD (hazard ratio: 1.28; 95% confidence interval: 1.07–1.53).
Commentary from Dr. Manoj Gupta (New York, USA), section editor of Pediatric & Fetal Cardiology Journal Watch: A countrywide cohort study was performed to calculate the relative risk and cumulative incidence of pneumonia hospitalizations and resultant 30-day mortality amongst the adult CHD population, matched 1:10 with non-CHD persons by gender, age, and adjusted for comorbidities. Those with CHD have a twofold
risk of a community-acquired pneumonia-related hospitalizations compared to age- and sex-matched members of the general population.
Cumulative incidence of community-acquired pneumonia-related hospitalization in adults with CHD and a general population comparison cohort, with death as competing risk. General population cohort matched on age and gender. CHD = congenital heart disease.
In addition, CHD patients experienced a longer hospitalization period prior to discharge. This highlights the reality that admissions in this population, even when unrelated to their CHD, can lead to greater incremental risk and cost, both direct and indirect, when compared to the general population.