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Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease.

Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease.
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Bornheimer R, Shea KM, Sato R, Weycker D, Pelton SI,


Bornheimer R, Shea KM, Sato R, Weycker D, Pelton SI, (click to view)

Bornheimer R, Shea KM, Sato R, Weycker D, Pelton SI,

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PloS one 2017 10 1312(10) e0184877 doi 10.1371/journal.pone.0184877
Abstract
BACKGROUND
Recent evidence demonstrates increased short-term risk of cardiac complications and respiratory failure among patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD), respectively, concurrent with an episode of community-acquired pneumonia (CAP). We evaluated patients with pre-existing HF or COPD, beginning 30 days after CAP diagnosis, to determine if CAP had a prolonged impact on their underlying comorbidity.

METHODS
A retrospective matched-cohort design using US healthcare claims was employed. In each month of accrual, patients with HF or COPD who developed CAP ("CAP patients") were matched (1:1, without replacement, on demographic and clinical profiles) to patients with HF or COPD who did not develop CAP ("comparison patients"). All patients were aged ≥40 years, and were pneumonia free during prior 1-year period. Exacerbation beginning 30 days after the CAP diagnosis and for the subsequent 1-year period were compared between CAP and comparison patients.

FINDINGS
38,010 (4·6%) HF patients and 48,703 (5·9%) COPD patients experienced a new CAP episode requiring hospitalization or outpatient care only, and were matched to comparison patients. In the HF subset, CAP patients were 47·2% more likely to experience an exacerbation vs patients without CAP (17·8% vs. 12·1%; p<0·001); in the COPD subset, CAP patients were 42·3% more likely to experience an exacerbation (16·2% vs. 11·4%; p<0·001). CONCLUSIONS
Our data provide evidence that CAP foreshadows a prolonged increase in risk of exacerbation of underlying HF or COPD in adults, and suggests a potential benefit to CAP prevention strategies.

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