Bornheimer Rebecca, Shea Kimberly M, Sato Reiko, Weycker Derek, Pelton Stephen I
Policy Analysis Inc. (PAI), Brookline, MA, United States of America.
Boston University Schools of Medicine and Public Health, Boston, MA, United States of America.
PLoS One. 2017 Oct 13;12(10):e0184877. doi: 10.1371/journal.pone.0184877. eCollection 2017.
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.
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.
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).
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.
最近有证据表明，心力衰竭（HF）患者并发社区获得性肺炎（CAP）时，短期内心脏并发症风险增加；慢性阻塞性肺疾病（COPD）患者并发CAP时，短期呼吸衰竭风险增加。我们对已患有HF或COPD的患者进行评估，从CAP诊断后30天开始，以确定CAP对其基础合并症是否有长期影响。
采用回顾性匹配队列设计，利用美国医疗保健索赔数据。在每个积累月份中，将发生CAP的HF或COPD患者（“CAP患者”）与未发生CAP的HF或COPD患者（“对照患者”）进行匹配（1:1，不重复，根据人口统计学和临床特征）。所有患者年龄≥40岁，且在过去1年期间无肺炎。比较CAP患者和对照患者在CAP诊断后30天及随后1年期间的病情加重情况。
38010例（4.6%）HF患者和48703例（5.9%）COPD患者经历了仅需住院或门诊治疗的新CAP发作，并与对照患者进行了匹配。在HF亚组中，CAP患者病情加重的可能性比未发生CAP的患者高47.2%（17.8%对12.1%；p<0.001）；在COPD亚组中，CAP患者病情加重的可能性高42.3%（16.2%对11.4%；p<0.001）。
我们的数据表明，CAP预示着成人潜在HF或COPD病情加重风险会长期增加，并提示CAP预防策略可能有益。
