Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study
Authors: Pieralli Filippo , Vannucchi Vieri , Nozzoli Carlo , Augello Giuseppe , Dentali Francesco , De Marzi Giulia , Uomo Generoso , Risaliti Filippo , Morbidoni Laura , Mazzone Antonino , Santini Claudio , Tirotta Daniela , Corradi Francesco , Gerloni Riccardo , Gnerre Paola , Gussoni Gualberto , Valerio Antonella , Campanini Mauro , Manfellotto Dario , Fontanella Andrea ,   for the FADOI-ICECAP Study Group, Attardo T. , Augello G. , Dentali F. , Tavecchia L. , Gessi V. , Pieralli F. , De Marzi G. , Torrigiani A. , Corbo L. , Uomo G. , Gallucci F. , Mastrobuoni C. , Risaliti F. , Giani A. , Morbidoni L. , Teodora Consalvo , Mazzone A. , Ricchiuti E. , Santini C. , Rosato A. , Tirotta D. , Giampaolo L. , Corradi F. , Torrigiani A. , Di Gregorio S. , Gerloni R. , Parodi L. , Gnerre P. , Vannucchi V. , Pallini F. , Landini G. , Giuri P. , Prampolini G. , Arioli D. , Leone M. C. , Canale C. , Condemi F. , Lupica R. , Manzola F. , Mascianà R. , Agnelli G. , Becattini C. , D’Agostini E. , Mosconi M. G. , Bogliari G. , Rossi A. , Campanini M. , Iannantuoni G. , Bartolino L. , Montagnani A. , Verdiani V. , Gambacorta M. , Lenti S. , Francioni S. , Giorgi-Pierfranceschi M. , Cattabiani C. , Orlandini F. , Scuotri L. , La Regina M. , Corsini F. , Anastasio L. , Mumoli N. , Mazzi V. , Camaiti A. , Balbi G. , Ragazzo F. , Pengo M. 
Published: January 2021

Abstract
Background
The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs).

Methods
This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation.

Results
A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14–2.51; p = 0.009).

Conclusion
Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile.

Trial registration
NCT03798457
Registered 10 January 2019 - Retrospectively registered