Differential Impact of Systolic and Diastolic Heart Failure on In-Hospital Treatment, Outcomes, and Cost of Patients Admitted for Pneumonia.

Autor:	Halabi JE; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio., Hariri E; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio., Pack QR; Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA., Guo N; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio.; Department of Quantitative Health Sciences, Cleveland Clinic, Ohio., Yu PC; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio.; Department of Quantitative Health Sciences, Cleveland Clinic, Ohio., Patel NG; Department of Medicine, Northwestern Medicine, Chicago, IL., Imrey PB; Department of Quantitative Health Sciences, Cleveland Clinic, Ohio.; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University., Rothberg MB; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio.
Jazyk:	angličtina
Zdroj:	American journal of medicine open [Am J Med Open] 2023 Jun; Vol. 9. Date of Electronic Publication: 2023 May 19.
DOI:	10.1016/j.ajmo.2022.100025
Abstrakt:	Background: Patients admitted with pneumonia and heart failure (HF) have increased mortality and cost compared to those without HF, but it is not known whether outcomes differ between systolic and diastolic HF. Management of concomitant pneumonia and HF is complicated because HF treatments can worsen complications of pneumonia. Methods: This is a retrospective cohort study from the Premier Database among patients admitted with pneumonia between 2010-2015. Patients were categorized based on systolic, diastolic, and combined HF using ICD-9 codes. The primary outcome was in-hospital mortality. Secondary outcomes included use of HF medications, length of stay, cost, intensive care unit (ICU) admission, as well as use of invasive mechanical ventilation (IMV), vasopressors and inotropes. Multivariable logistic regression was used to describe associations of these outcomes with type of HF. Results: Of 123,211 patients with pneumonia and HF, 41,196 (33.4%) had systolic HF, 69,982 (56.8%) diastolic HF, and 12,033 (9.8%) had combined HF. Compared to patients with diastolic HF, after multivariable adjustment systolic HF was associated with higher in-hospital mortality (OR 1.15; 95% CI:1.11-1.20), ICU admission, and use of IMV and vasoactive agents, but not with increased length of stay or cost. Among patients with systolic HF, 80% received a loop diuretic, 72% a beta blocker, 48% angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and 12.5% a mineralocorticoid receptor antagonist. Conclusion: Systolic HF is associated with added risk in pneumonia compared to diastolic HF. There may also be an opportunity to optimize medications in systolic HF prior to discharge. Competing Interests: Declaration of Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Databáze:	MEDLINE
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