Pneumonia: An Arrhythmogenic Disease?
Pneumonia: An Arrhythmogenic Disease?
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DOI：
10.1016/j.amjmed.2012.08.005
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发表时间：
2013-01-01
影响因子：
5.9
通讯作者：
Mortensen, Eric M.
中科院分区：
文献类型：
--
作者：
Soto-Gomez, Natalia;Anzueto, Antonio;Mortensen, Eric M.
背景技术背景：最近的研究表明，肺炎后心血管疾病增加;然而，关于肺炎后心律失常的信息很少。本研究的目的是评估肺炎住院后心律失常的发生率和危险因素。我们使用退伍军人事务部的管理数据进行了一项全国性队列研究，包括2002-2007财政年度因肺炎住院的年龄≥ 65岁的患者，在入院后48小时内接受抗生素治疗，既往未诊断出心律失常，并接受过至少1年的退伍军人事务部护理。我们仅纳入了首次肺炎相关住院病例，随访时间为入院后90天。心律失常包括房颤、室性心动过速/房颤、心脏骤停和症状性心动过缓。我们使用了一个多水平回归模型，调整入院医院，以检查心律失常的危险因素。结果：我们确定了32,689例符合纳入标准的患者。其中，3919例（12%）在入院后90天内新诊断为心律失常。与心律失常风险增加显著相关的变量包括年龄增加、充血性心力衰竭病史和需要机械通气或血管加压药。β受体阻滞剂的使用与事件发生率的降低有关。结论：大量患者在肺炎住院期间和住院后出现新的心律失常。需要进一步的研究来确定使用心脏保护药物是否会改善因肺炎住院的患者的预后。因肺炎住院的高危患者应在住院期间监测心律失常。由爱思唯尔公司出版美国医学杂志（2013）126，43-48
BACKGROUND: Recent studies suggest that there is an increase in cardiovascular disease after pneumonia; however, there is little information on cardiac arrhythmias after pneumonia. The aims of this study were to assess the incidence of, and examine risk factors for, cardiac arrhythmias after hospitalization for pneumonia.METHODS: We conducted a national cohort study using Department of Veterans Affairs administrative data including patients aged >= 65 years hospitalized with pneumonia in fiscal years 2002-2007, receiving antibiotics within 48 hours of admission, having no prior diagnosis of a cardiac arrhythmia, and having at least 1 year of Veterans Affairs care. We included only the first pneumonia-related hospitalization, and follow-up was for the 90 days after admission. Cardiac arrhythmias included atrial fibrillation, ventricular tachycardia/fibrillation, cardiac arrest, and symptomatic bradycardia. We used a multilevel regression model, adjusting for hospital of admission, to examine risk factors for cardiac arrhythmias.RESULTS: We identified 32,689 patients who met the inclusion criteria. Of these, 3919 (12%) had a new diagnosis of cardiac arrhythmia within 90 days of admission. Variables significantly associated with increased risk of cardiac arrhythmia included increasing age, history of congestive heart failure, and a need for mechanical ventilation or vasopressors. Beta-blocker use was associated with a decreased incidence of events.CONCLUSION: An important number of patients have new cardiac arrhythmia during and after hospitalization for pneumonia. Additional research is needed to determine whether use of cardioprotective medications will improve outcomes for patients hospitalized with pneumonia. At-risk patients hospitalized with pneumonia should be monitored for cardiac arrhythmias during the hospitalization. Published by Elsevier Inc. The American Journal of Medicine (2013) 126, 43-48