Background Community-acquired pneumonia (CAP) has high mortality, from 5 to 18.3%.1 Arrhythmias are a recognised significant complication. Growing evidence associates this treatable complication with increases in mortality. No review has summated data on mortality or ways to improve outcome.
Aims This review aimed to define the extent of the problem, collate and appraise evidence regarding outcomes and management, and identify gaps in understanding.
Methods Narrative review using a systematic protocol. Medline, ProQuest, Web of Science were searched for papers reporting adults with CAP complicated by arrhythmia. 382 articles were assessed and excluded based on title (348), abstract (27) and full text (6), leaving 11. Review of bibliographies added 3, totalling 14. These were appraised and coded, with Newcastle-Ottawa scores assigned.
Results Three reviews and 11 primary studies were included: 10 Cohorts (4 prospective, 6 retrospective) and one case series. One meta-analysis of cardiac events identified a pooled incidence of 4.7% for CAP inpatients developing arrhythmia.2 N-O scores ranged from 5 to 9, Median 7.5. Outcomes reported: Incidence; 30 and 90 day mortality; Re-hospitalisation; predisposing factors. Only one paper commented on treatment.
Discussion There is high quality evidence of a link between CAP and arrhythmogenesis. Data linking it to mortality suggest a strong association with worse outcome. This review was limited by its single reviewer. Some evidence was limited by retrospective study designs and biassed populations. The strengths of this review lie in its reproducible systematic methods and clear outlining of gaps in our understanding of this phenomenon, particularly regarding best management.
Conclusion New arrhythmia complicating CAP is a recognised phenomenon that carries morbidity and mortality. Notably, no research has been reported on how best to manage this complication – reflected by the guidelines for the respective diseases in isolation. The next step is to look at how this complication is managed and identify the best approach to improve patient outcomes.
References 1 Lim WS, Woodhead M. BTS adult CAP audit 2009/10. Thorax 2011;66(6):548–549
2 Corrales-Medina VF, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011;8(6):779