Prognostic Implications of Concomitant Pneumonia in Acute Heart Failure Patients Who Underwent Noninvasive Positive Pressure Ventilation

Background: Heart failure may increase risk of pneumonia due to alveoli flooding and reduced microbial clearance. Conversely, pneumonia may induce or worsen heart failure as cardiac output fails to meet the needs during infection. Although noninvasive positive pressure ventilation (NPPV) reduces mortality of patients with acute pulmonary edema, the relationship between concomitant pneumonia and outcome of acute heart failure (AHF) patients treated with NPPV is poorly understood. Hence, we investigated the association between concomitant pneumonia and outcome in hospitalized AHF patients who underwent NPPV. Methods and Results: In 174 consecutive AHF patients treated with NPPV (enrolled from July 2013 to June 2016), 34 (19.5%) had concomitant pneumonia on admission. Patients with pneumonia was older, had higher left ventricular ejection fraction, and had lower B-type natriuretic peptide level than those without. However, there were no significant differences with respect to initial NPPV setting between the groups. In multivariable analysis, concomitant pneumonia was independently associated with higher in-hospital mortality (adjusted odds ratio 3.01; P = .028). Additionally, the 6-month mortality among patients with pneumonia was also significantly higher than that among those without (32.4% vs. 15.7%; Log-rank P = .008). Conclusions: Concomitant pneumonia on admission was associated with not only in-hospital short-term outcome, but also 6-month medium-term prognosis in AHF patients who underwent NPPV. Careful observation during NPPV might be needed in AHF patients with pneumonia.