1. Incidence and Outcomes of Pneumonia in Patients With Heart Failure
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Marc A. Pfeffer, Felipe Martinez, Pardeep S. Jhund, Orly Vardeny, Michael R. Zile, Muthiah Vaduganathan, Jean L. Rouleau, Dirk J. van Veldhuisen, Karl Swedberg, Aldo P. Maggioni, Akshay S. Desai, Faiez Zannad, John J.V. McMurray, Milton Packer, Inder S. Anand, Li Shen, Ankeet S. Bhatt, Scott D. Solomon, Adel R. Rizkala, Cardiovascular Centre (CVC), Hangzhou Normal University, British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), University of Glasgow-NHS Greater Glasgow and Clyde, University of Minnesota Medical School, University of Minnesota System, Minneapolis Veterans Administration Medical Center, Brigham & Women’s Hospital [Boston] (BWH), Harvard Medical School [Boston] (HMS), Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri] (ANMCO Research Center), Associazione Nazionale Medici Cardiologi Ospedalieri [Firenze] (ANMCO), Universidad Nacional de Córdoba [Argentina], Novartis Pharmaceutical Corporation, Montreal Heart Institute - Institut de Cardiologie de Montréal, University of Gothenburg (GU), University of Minneapolis, University Medical Center Groningen [Groningen] (UMCG), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Ralph H. Johnson Veteran's Administration Medical Center, Medical University of South Carolina [Charleston] (MUSC), Baylor College of Medecine, and The PARADIGM-HF and PARAGON-HF trials were funded by Novartis
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medicine.medical_specialty ,heart failure ,030204 cardiovascular system & hematology ,NEPRILYSIN INHIBITION ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Community-acquired pneumonia ,Internal medicine ,medicine ,pneumonia ,030212 general & internal medicine ,risk ,First episode ,Ejection fraction ,biology ,business.industry ,MORTALITY ,Incidence (epidemiology) ,Hazard ratio ,COMMUNITY-ACQUIRED PNEUMONIA ,Angiotensin-converting enzyme ,ASSOCIATION ,ADULTS ,vaccination ,medicine.disease ,3. Good health ,Pneumonia ,PRESERVED EJECTION FRACTION ,Heart failure ,incidence ,RISK-FACTORS ,biology.protein ,Cardiology and Cardiovascular Medicine ,business - 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) (J Am Coll Cardiol 2021;77:1961-73) (c) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 2021