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Risk factors and lifelong impact of community-acquired pneumonia in congenital heart disease

Published online by Cambridge University Press:  09 December 2020

Patrick D. Evers Open the ORCID record for Patrick D. Evers [Opens in a new window] ,
Dóra K. Farkas ,
Michael Khoury ,
Morten Olsen  and
Nicolas L. Madsen
Patrick D. Evers*
Affiliation:
Division of Pediatric Cardiology, Oregon Health and Sciences University, Portland, OR, USA
Dóra K. Farkas
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Michael Khoury
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Canada
Morten Olsen
Affiliation:
Department of Radiology, Horsens Regional Hospital, Aarhus, Denmark
Nicolas L. Madsen
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Author for correspondence: P. Evers, MD MSc, Division of Pediatric Cardiology, Oregon Health and Sciences University, 707 SW Gaines St. CDRC-P, Portland, OR97239, USA. Tel: (503) 494-4429. E-mail: eversp@ohsu.edu
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Abstract

Introduction:

The prevalence of congenital heart disease (CHD) in adults is rising necessitating a greater understanding of acquired diseases such as community-acquired pneumonia, which remains a leading cause of age-related mortality and morbidity in the general population. We hypothesise that the CHD population, given cardiopulmonary mechanics and altered immune function, bears a uniquely high risk for pneumonia-related hospitalisations and mortality.

Methods:

A countrywide cohort study was performed to calculate the relative risk and cumulative incidence of pneumonia hospitalisations and resultant 30-day mortality amongst the adult CHD population, matched 1:10 with non-CHD persons by gender, age, and adjusted for comorbidities. Cox proportional hazard regression quantified the impact of CHD severity and extracardiac defects.

Results:

The CHD cohort includes 17,162 adults. The majority demonstrate mild/moderate CHD complexity. The cumulative incidence of pneumonia hospitalisation was higher for adults with CHD (hazard ratio 1.90; 95% confidence interval: 1.74–2.06) than the comparison cohort. This risk was increased for those with extracardiac defects or a syndrome (hazard ratio: 4.34; 95% confidence interval: 3.39–5.54). Additionally, CHD individuals with severe/univentricular subtypes demonstrate a heightened risk compared to the non-CHD cohort (hazard ratio: 2.35; 95% confidence interval: 1.94–2.84), as well as compared to those with mild/moderate CHD (hazard ratio: 1.28; 95% confidence interval: 1.07–1.53). In addition, pneumonia hospitalisation mortality was elevated above the comparison population with a 30-day mortality rate ratio of 1.31 (95% confidence interval: 1.00–1.73).

Conclusion:

Adults with CHD are at elevated risk of pneumonia hospitalisations and pneumonia-associated mortality. This risk is further elevated in those with severe CHD and extracardiac defects.

Keywords

Heart defectscongenitalpneumoniahospitalisationregistries
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 446 - 451
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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