■与没有心力衰竭(HF)的患者相比,接受肺炎和心力衰竭(HF)的患者死亡率和费用增加。但尚不清楚收缩性和舒张性HF的结局是否不同.合并的肺炎和HF的管理是复杂的,因为HF治疗可恶化肺炎的并发症。
■这是Premier数据库中2010-2015年收治的肺炎患者的回顾性队列研究。根据收缩压对患者进行分类,舒张压,并使用ICD-9代码组合HF。主要结果是院内死亡率。次要结果包括使用HF药物,逗留时间,成本,重症监护病房(ICU)入院,以及有创机械通气(IMV)的使用,血管加压药和肌力药。多变量逻辑回归用于描述这些结果与HF类型的关联。
■在123,211例肺炎和HF患者中,41,196(33.4%)有收缩期HF,69,982(56.8%)舒张性HF,和12,033(9.8%)合并HF。与舒张性HF患者相比,多变量校正后收缩期HF与住院死亡率较高相关(OR1.15;95%CI:1.11-1.20),入住ICU,以及使用IMV和血管活性剂,但不会增加停留时间或费用。在收缩期HF患者中,80%接受了环状利尿剂,72%的β一受体阻滞剂,48%血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂,和12.5%盐皮质激素受体拮抗剂。
■与舒张性HF相比,收缩性HF与肺炎风险增加相关。也可能有机会在出院前优化收缩期HF的药物治疗。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.