Predictors of secondary cardiovascular events in older adults with community-acquired pneumonia: a prospective...

Older adults hospitalized with Community-Acquired Pneumonia (CAP) frequently experience early secondary cardiovascular events. The authors quantified risk factors and the incremental value of frailty and cardiac biomarkers beyond the Pneumonia Severity Index (PSI).

The authors ran a single-center, prospective cohort of adults ≥65-years with CAP admitted between January and December 2024. The primary endpoint was any in-hospital SCE (acute heart failure, MI/ACS per Fourth Universal Definition, new atrial fibrillation/flutter, ischemic stroke/TIA, or cardiovascular death). Prespecified predictors were prior cardiovascular disease, PSI, Clinical Frailty Scale (CFS), High-Sensitivity Troponin (hs-cTn), and NT-proBNP. Penalized multivariable logistic regression estimated adjusted odds ratios, 30- and 90-day outcomes were used to cause-specific Cox and Fine-Gray models.

Among 172 patients (median age 77; 46% women), in-hospital SCEs occurred in 27.9% patients (48 out of 172 patients with 65 total component events; 95% CI 21.7-35.0), and 68.8% occurred within 72 h. Specifically, heart failure was 18.0%, new atrial fibrillation was 9.9%, MI was 5.8%, and cardiovascular death was 2.9%. In multivariable analysis, CFS ≥ 5 (Aor = 2.07, 95% CI 1.03-4.17), abnormal hs-cTn (aOR = 2.52, 1.25-5.06), and NT-proBNP per doubling (aOR = 1.38, 1.12-1.71) independently predicted SCEs. Discrimination improved from AUC 0.68 (PSI) to 0.73 with CFS and 0.79 with biomarkers (optimism-corrected 0.77), with NRI +0.18 and decision-curve net benefit at 10%-25% thresholds. Cumulative SCE incidence was 33.7% at 30-days and 37.8% at 90-days. Fine-Gray results were consistent.

SCEs were common and occurred early after admission. Adding frailty and cardiac biomarkers to PSI improved risk stratification and may help high-risk patients receive closer monitoring. External validation is needed before its clinical application.