The impact of pre-existing heart failure on pneumonia prognosis: population-based cohort study

J Gen Intern Med. 2008 Sep;23(9):1407-13. doi: 10.1007/s11606-008-0672-3. Epub 2008 Jun 24.


Background: There are limited data describing how pre-existing heart failure affects mortality following pneumonia.

Objective: To examine the association between history and severity of heart failure and mortality among patients hospitalized for pneumonia.

Design: Population-based cohort study in Western Denmark between 1994 and 2003.

Patients: 33,736 adults with a first-time hospitalization for pneumonia. Heart failure was identified and categorized based on data linked from population-based health care databases.

Measurements: We compared 30-day mortality between patients with pre-existing heart failure and other pneumonia patients, while adjusting for age, gender, comorbidity, and medication use.

Results: The 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.

Conclusion: History and severity of heart failure are associated with a poor outcome for patients hospitalized with pneumonia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Denmark / epidemiology
  • Female
  • Heart Failure / complications*
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Pneumonia / complications*
  • Pneumonia / mortality*
  • Retrospective Studies