Abstract :
Background: Heart failure is a common clinical manifestation of most organic heart diseases that progress to the end stage. Patients with heart failure are often accompanied by secondary conditions such as pulmonary circulatory congestion and pulmonary edema, which can lead to dyspnea, gas exchange disorders, and other consequences, creating certain conditions for pathogens to invade and colonize the lungs. Therefore, patients with heart failure may have higher risk of pulmonary infection.
Aim: This study aimed to assess the prevalence of chest infection among patients with heart failure and to determine the characteristics of the patients with heart failure who had chest infection and the potential risk factors.
Methods: A retrospective, descriptive cross-sectional study was carried out at internal medicine department, Al-Wahdah Teaching Hospital, Dhamar, Yemen over six months (June – December 2022). A total of 100 patients were enrolled in our study. A semi-structured questionnaire was designed and used for data collection.
Results: A total of 100 heart failure patients including 53 (53%) males, and 47 (47%) females were successfully enrolled in this study. The majority of participated patients were of age group 40 – 60 years (55%), and were of rural residence (83%). Chest infection was documented in approximately two-thirds of included patients (63%). Chest infection was documented in majority of patients who were smokers, Qat chewer, shamma intakes, being obese, had cardiomyopathy, as well as those patients who had dyspnea of NYHA class III & IV, orthopnea, PND, productive cough, high sputum amount, whitish sputum color, peripheral chest pain, fatigue, sweating, fever and high WBC count, such associations were significant statistically.
Conclusion: This study revealed that, chest infection in heart failure patients was common with overall prevalence of (63%) among included patients this study was. Based on this, an early prevention and intervention measures should be taken to reduce pulmonary infections in patients with heart failure.
Keywords :
Chest infection, heart failure, YemenReferences :
- Neumann T, Biermann J, Erbel R, et al. Heart failure: the commonest reason for hospital admission in Germany: medical and economic perspectives. Dtsch Arztebl Int 2009; 106: 269–275.
- Mozaffarian D, Benjamin EJ, Go AS, et al.; Writing Group Members. Executive summary: Heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation 2016; 133: 447–454.
- Solomon SD, Dobson J, Pocock S, et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation 2007; 116: 1482–1487.
- Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med 2008; 168: 847–854.
- Michalsen A, Konig G and Thimme W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 1998; 80: 437–441.
- Opasich C, Febo O, Riccardi PG, et al. Concomitant factors of decompensation in chronic heart failure. Am J Cardiol 1996; 78: 354–357.
- Kapoor JR, Kapoor R, Ju C, et al. Precipitating clinical fac-tors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. JACC Heart Fail 2016; 4: 464–472.
- Salamanca-Bautista P, Conde-Martel A, Aramburu-Bodas O, et al. Precipitating factors of heart failure admission: differences related to age and left ventricular ejection fraction. Int J Cardiol 2016; 219: 150–155.
- Bartlett B, Ludewick HP, Lee S, Dwivedi G. Cardiovascular complications following pneumonia: focus on pneumococcus and heart failure. Curr Opin Cardiol 2019;34:233–9.
- Corrales-Medina VF, Musher DM, Shachkina S, Chirinos JA. Acute pneumonia and the cardiovascular system. Lancet 2013;381:496–505.
- Corrales-Medina VF, Musher DM, Wells GA, et al. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012;125:773–81.
- Chalmers J, Campling J, Ellsbury G, et al. Community-acquired pneumonia in the United Kingdom: a call to action. Pneumonia (Nathan) 2017;9:15.
- Naucler P, Henriques-Normark B, Hedlund J, et al. The changing epidemiology of community- acquired pneumonia: nationwide register-based study in Sweden. J Intern Med 2019;286:689–701
- Sun X, Douiri A, Gulliford M. Pneumonia incidence trends in UK primary care from 2002 to 2017: population-based cohort study. Epidemiol Infect 2019;147:e263.
- Jobs A, Simon R, de Waha S, et al. Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients. Eur Heart J Acute Cardiovascular Care 2018;7:362–70.
- Alon D, Stein GY, Korenfeld R, Fuchs S. Predictors and outcomes of infection-related hospital admissions of heart failure patients. PLoS One 2013;8:e72476.
- Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med 2008;168:847–54.
- Brotherton AL, Shah R. Recent updates to the advisory committee on immunization practices recommendations for pneumococcal and herpes zoster vaccination. R I Med J 2020;103:34–7.
- van Buynder P, Booy R. Pneumococcal vaccination in older persons: where are we today? Pneumonia (Nathan) 2018;10:1.
- Bonten MJ, Huijts SM, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med 2015;372:1114–25.
- Bhatt AS, Liang L, DeVore AD, et al. Vaccination trends in patients with heart failure: insights from Get With the Guidelines—Heart Failure. J Am Coll Cardiol HF 2018;6:844–55.
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129–200.
- Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62:e147–239.
- Shah SJ, Gheorghiade M. Heart failure with preserved ejection fraction: treat now by treating comorbidities. JAMA 2008;300:431–3.
- Lieberman D, Shvartzman P, Korsonsky I, et al. Diagnosis of ambulatory community-acquired pneumonia. Comparison of clinical assessment versus chest X-ray. Scand J Prim Health Care 2003; 21: 57–60.
- van Vugt SF, Verheij TJ, de Jong PA, et al. Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography. Eur Respir J 2013; 42: 1076–1082.
- Metlay JP, Schulz R, Li YH, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med 1997; 157: 1453–1459.
- Ewig S, Hoffken G, Kern WV, et al. [Management of adult community-acquired pneumonia and prevention – update 2016]. Pneumologie 2016; 70: 151–200.
- Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl 2): S27–S72.
- Watkins RR and Lemonovich TL. Diagnosis and manage-ment of community-acquired pneumonia in adults. Am Fam Physician 2011; 83: 1299–1306.
- Kalogeropoulos AP, Tang WH, Hsu A, et al. High-sensitivity C-reactive protein in acute heart failure: insights from the ASCEND-HF trial. J Card Fail 2014; 20: 319–326.
- Nadar S, Prasad N, Taylor RS, Lip GY. Positive pressure ventilationin the management of acute and chronic cardiac failure: a systematic review and meta-analysis. Int J Cardiol 2005;99(2):171–185.
- Khand A, Gemmel I, Clark AL, Cleland JG. Is the prognosis of heartfailure improving? J Am Coll Cardiol 2000;36(7):2284–2286.
- Caruana L, Petrie MC, Davie AP, McMurray JJ. Do patients withsuspected heart failure and preserved left ventricular systolic function suffer from “diastolic heart failure” or from misdiagnosis? A prospective descriptive study. BMJ 2000;321(7255):215–218.
- McMurray JJ, Pfeffer MA. Heart failure. Lancet 2005;365(9474): 1877–1889.
- Brausnwald E. Disorders of the heart: normal and abnormal myocardial function. In: Fauci AS, editor. Harrison’s principles of internal medicine, 14th ed. New York: McGraw-Hill; 1998: 1278–1286.
- Aurigemma GP, Gaasch WH. Clinical practice: diastolic heart failure. N Engl J Med 2004;351(11):1097–1105.
- Kitzman DW. Exercise intolerance. Prog Cardiovasc Dis 2005;47(6): 367–379.
- Mancini DM. Pulmonary factors limiting exercise capacity in patients with heart failure. Prog Cardiovasc Dis 1995;37(6):347–370.
- Choudhury L, Gheorghiade M, Bonow RO. Coronary artery diseasein patients with heart failure and preserved systolic function. Am J Cardiol 2002;89(6):719–722.
- Jessup M, Brozena S. Heart failure. N Engl J Med 2003;348(20): 2007–2018.
- Eichhorn EJ, Bristow MR. Medical therapy can improve the biological properties of the chronically failing heart: a new era in the treatment of heart failure. Circulation 1996;94(9):2285–2296.
- Gehlbach BK, Geppert E. The pulmonary manifestations of left heartfailure. Chest 2004;125(2):669–682.
- West JB, Dollery CT, Naimark A. Distribution of blood flow inisolated lung: relation to vascular and alveolar pressures. J Appl Physiol 1964;19:713–724.
- Malik A, Vogel SM, Minshall RD, et al. Pulmonary circulation andregulation of fluid balance. In: Murray JF, Nadel JA, Mason RJ, et al, editors. Textbook of respiratory medicine. Philadelphia: Saunders; 2000:19–54.
- Tsukimoto K, Mathieu-Costello O, Prediletto R, Elliott AR, WestJB. Ultrastructural appearances of pulmonary capillaries at high transmural pressures. J Appl Physiol 1991;71(2):573–582.
- Davie AP, Francis CM, Caruana L, Sutherland GR, McMurray JJ.Assessing diagnosis in heart failure: which features are any use? QJM 1997;90(5):335–339.
- Stevenson LW, Perloff JK. The limited reliability of physical signsfor estimating hemodynamics in chronic heart failure. JAMA 1989; 261(6):884–888.
- Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA 2002;287(5):628–640.
- Grady KL, Dracup K, Kennedy G, Moser DK, Piano M, Stevenson LW, Young JB. Team management of patients with heart failure: a statement for healthcare professionals from The Cardiovascular Nursing Council of the American Heart Association. Circulation 2000; 102(19):2443–2456
- He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK.Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 2001; 161(7):996–1002.
- de Denus S, Pharand C, Williamson DR. Brain natriuretic peptide inthe management of heart failure: the versatile neurohormone. Chest 2004;125(2):652–668.
- Maisel A. B-type natriuretic peptide measurements in diagnosingcongestive heart failure in the dyspneic emergency department patient. Rev Cardiovasc Med 2002;3 Suppl 4:S10–S17.
- Yancy CW, Jessup M, Bozkurt B, et al, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15. 128(16):e240-327.
- Lindenfeld J, Albert NM, Boehmer JP, et al, for the Heart Failure Society of America. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010 Jun. 16(6):e1-194.
- MacDonald MR, Connelly DT, Hawkins NM, et al. Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart. 2011 May. 97(9):740-7.
- Ponikowski P, Voors AA, Anker SD, et al, for the Authors/Task Force Members. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14. 37(27):2129-200.
- Mozaffarian D, Lemaitre RN, King IB, et al. Circulating long-chain omega-3 fatty acids and incidence of congestive heart failure in older adults: the cardiovascular health study: a cohort study. Ann Intern Med. 2011 Aug 2. 155(3):160-70.
- Mozaffarian D, Lemaitre RN, King IB, et al. Circulating long-chain omega-3 fatty acids and incidence of congestive heart failure in older adults: the cardiovascular health study: a cohort study. Ann Intern Med. 2011 Aug 2. 155(3):160-70.
- Yancy CW, Jessup M, Bozkurt B, et al, for the Writing Committee Members. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2016 Sep 27. 134(13):e282-93.
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a eeport of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3. 79 (17):e263-e421.
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: executive summary: s report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3. 145 (18):e876-94.
- Stiles S. New HF guidelines feature ‘quad’ therapy, tweaked terminology. Medscape Medical News. Available at https://www.medscape.com/viewarticle/971492. April 3, 2022; Accessed: May 6, 2022.
- Pina IL. Key points from the new heart failure guidelines [commentary]. TheHeart.org. Available at https://www.medscape.com/viewarticle/971949. May 4, 2022; Accessed: May 6, 2022.
- Tejada S, Romero A, Rello J. Community-Acquired Pneumonia in Adults: What’s New Focusing on Epidemiology, Microorganisms and Diagnosis? Erciyes Med J 2018; 40(4): 177-82.
- El-Emshaty W, Mashaly M, Moawad A, El-Gamal M, Hewidy A. Diagnostic value of neutrophil lymphocyte ratio versus C-reactive protein in discrimination between different pathogens causing community-acquired pneumonia. Comp Clin Path 2017; 26(4): 757-65.
- World Population Prospects: The 2017 Revision | Multimedia Library – United Nations Department of Economic and Social Affairs. Available from: https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.htm
- Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-Acquired pneumonia requiring hospitalization among U.S. adults. N Eng J Med 2015; 373: 415-27.
- Cillóniz C, Rodríguez-Hurtado D, Torres A. Characteristics and Management of Community-Acquired Pneumonia in the Era of Global Aging. Med Sci 2018; 6(2): 35.
- Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl 2): 27-72.
- Rello J. Demographics, guidelines, and clinical experience in severe community-acquired pneumonia. Crit Care 2008; 12(6): 2.
- Tokgoz Akyil FT, Yalcinsoy M, Hazar A, Cilli A, Celenk B, Kilic O, et al. Prognosis of hospitalized patients with community-acquired pneumonia. Pulmonology 2018; 24(3): 164-9.
- Musher DM, Abers MS, Bartlett JG. Evolving understanding of the causes of pneumonia in adults, with special attention to the role of pneumococcus. Clin Infect Dis 2017; 65(10): 1736-44.
- Torres A, Blasi F, Peetermans WE, Viegi G, Welte T. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis 2014; 33(7): 1065-79.
- Prina E, Ranzani OT, Polverino E, Cillóniz C, Ferrer M, Fernandez L, et al. Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc 2015; 12(2): 153-60.
- Gündüz C, Taşbakan MS, Sayıner A, Cilli A, Kılınç O, Şakar AC. Clinical characteristics and outcome of healthcare associated pneumonia in Turkey. Tuberk Toraks 2016; 64(3): 185-90.
- Erdogan H, Erdogan A, Lakamdayali H, Yilmaz A, Arslan H. Travel-associated Legionnaires disease: clinical features of 17 cases and a review of the literature. Diagn Microbiol Infect Dis 2010; 68(3): 297-303.
- Rello J, Lisboa T, Wunderink R. Severe community-acquired pneumonia and PIRO: A new paradigm of management. Curr Infect Dis Rep 2009; 11(5): 343-8.
- Rello J. Perez, A. Precision medicine for the treatment of severe pneumonia in intensive care. Expert Rev Respir Med 2016; 10(3): 297-316.
- Erdem H, Inan A, Altındis S, Carevic B, Askarian M, Cottle L, et al. Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran – A prospective multicenter point prevalence study. J Infect 2014; 68(2): 131-40.
- Serin DÇ, Pullukçu H, Çiçek C, Sipahi OR, Taşbakan S, Atalay, S. Bacterial and viral etiology in hospitalized community acquired pneumonia with molecular methods and clinical evaluation. J Infect Dev Ctries 2014; 8(04): 510-8.
- Rello J, van Engelen TSR, Alp E, Calandra T, Cattoir V, Kern WV, et al. Towards precision medicine in sepsis: a position paper from the European Society of Clinical Microbiology and Infectious Diseases. Clin Microbiol Infect 2018.
- Liu YF, Gao Y, Chen MF, Cao B, Yang XH, Wei L. Etiological analysis and predictive diagnostic model building of community-acquired pneu-monia in adult outpatients in Beijing, China. BMC Infect Dis 2013, 13(1): 309.
- Sulo G, Sulo E, Jorgensen T, et al. Ischemic heart failure as a complication of incident acute myocardial infarction: timing and time trends: a national analysis including 78,814 Danish patients during 2000-2009. Scand J Public Health 2020;48:294–302.
- DeFilippis EM, Reza N, Donald E, Givertz MM, Lindenfeld J, Jessup M. Considerations for heart failure care during the COVID-19 pandemic. JACC Heart Fail 2020;8:681–91.
- Yano T, Katano S, Kouzu H, et al. Distinct determinants of muscle wasting in nonobese heart failure patients with and without type 2 diabetes mellitus. J Diabetes 2021;13:07–18.
- Garcia AM, Beatty JT, Nakano SJ. Heart failure in single right ventricle congenital heart disease: physiological and molecular considerations. Am J Physiol Heart Circ Physiol 2020;318:H947–65.
- Rizzo P, Vieceli Dalla Sega F, Fortini F, Marracino L, Rapezzi C, Ferrari R. COVID-19 in the heart and the lungs: could we “Notch” the inflammatory storm? Basic Res Cardiol 2020;115:03.
- Marra AM, Benjamin N, Cittadini A, Bossone E, Grunig E. When pulmonary hypertension complicates heart failure. Heart Fail Clin 2020;16:53–60.
- Gologorsky RC, Roy S. Ultrafiltration for management of fluid overload in patients with heart failure. Artif Organs 2020;44:129–39.
- Anker SD, Butler J, Khan MS, et al. clinical trials in heart failure during (and after) the COVID-19 pandemic: an Expert Consensus Position Paper from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2020;41:2109–17.
- Kobayashi M, Voors AA, Girerd N, et al. Heart failure etiologies and clinical factors precipitating for worsening heart failure: Findings from BIOSTAT-CHF. Eur J Intern Med 2020;71:62–9.
- Hernandez G, Vaquero C, Colinas L, et al. Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients: a randomized clinical trial. JAMA 2016;316:1565–74.
- Koirala B, Budhathoki C, Dennison-Himmelfarb CR, Bhattarai P, Davidson PM. The self-care of heart failure index: a psychometric study. J Clin Nurs 2020;29:645–52.
- Brouch D, Tashtish N, Di Felice C, Longenecker CT, Al-Kindi SG. Human immunodeficiency virus infection and risk of heart failure rehospitalizations. Am J Cardiol 2019;124:1232–8.
- Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace 2015;17:767–77.
- Demissei BG, Cleland JG, O’Connor CM, et al. Procalcitonin-based indication of bacterial infection identifies high risk acute heart failure patients. Int J Cardiol 2016;204:164–71.
- Cardoso JN, Del Carlo CH, Oliveira Junior MT, Ochiai ME, Kalil Filho R, Barretto ACP. Infection in patients with decompensated heart failure: in-hospital mortality and outcome. Arq Bras Cardiol 2018;110:364–70.
- Staub LJ, Mazzali Biscaro RR, Kaszubowski E, Maurici R. Lung ultrasound for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of chronic obstructive pulmonary disease/asthma in adults: a systematic review and meta-analysis. J Emerg Med 2019;56:53–69.
- Vallabhajosyula S, Jentzer JC, Geske JB, et al. New-onset heart failure and mortality in hospital survivors of sepsis-related left ventricular dysfunction. Shock 2018;49:144–9.
- Orr NM, Boxer RS, Dolansky MA, Allen LA, Forman DE. Skilled nursing facility care for patients with heart failure: can we make it “heart failure ready?”. J Card Fail 2016;22:1004–14.
- Dolansky MA, Capone L, Leister E, Boxer RS. Targeting heart failure rehospitalizations in a skilled nursing facility : A case report. Heart Lung 2016;45:392–6.
- Unroe KT, Fowler NR, Carnahan JL, et al. Improving nursing facility care through an innovative payment demonstration project: optimizing patient transfers, impacting medical quality, and improving symptoms: transforming institutional care phase 2. J Am Geriatr Soc 2018;66:1625–31.
- Brennan EJ. Chronic heart failure nursing: integrated multidisciplinary care. Br J Nurs 2018;27:681–8.
- Sezgin D, Mert H, Ozpelit E, Akdeniz B. The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: A randomized controlled trial. Int J Nurs Stud 2017;70:17–26.
- Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N. Effect of beta-blockers on heart failure severity in patients with heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev 2021;26:165–71
- Tello K, Seeger W, Naeije R, et al. Right heart failure in pulmonary hypertension: Diagnosis and new perspectives on vascular and direct right ventricular treatment. Br J Pharmacol 2021;178:90–107.
- Zhang Z, Cao L, Chen R, et al. Electronic healthcare records and external outcome data for hospitalized patients with heart failure. Sci Data 2021;8:4
- Altibi AM, Prousi G, Agarwal M, et al. Readmission-free period and in-hospital mortality at the time of first readmission in acute heart failure patients-NRD-based analysis of 40,000 heart failure readmissions. Heart Fail Rev 2021;26:57–64
- Hinton RB, Ware SM. Heart failure in pediatric patients with congenital heart disease. Circ Res 2017;120:978–94.
- Hsue PY, Waters DD. Heart failure in persons living with HIV infection. Curr Opin HIV AIDS 2017;12:534–9.
- Correale M, Tarantino N, Petrucci R, et al. Liver disease and heart failure: back and forth. Eur J Intern Med 2018;48:25–34.
- Jobs, A., Simon, R., de Waha, S., Rogacev, K., Katalinic, A., Babaev, V., & Thiele, H. (2018). Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients. European Heart Journal: Acute Cardiovascular Care, 7(4), 362-370.
- Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med 2008; 168: 847–854
- Kapoor JR, Kapoor R, Ju C, et al. Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. JACC Heart Fail 2016;
- Salamanca-Bautista P, Conde-Martel A, Aramburu-Bodas O, et al. Precipitating factors of heart failure admission: differences related to age and left ventricular ejection fraction. Int J Cardiol 2016; 219: 150–155.
- Peng, Qi MMa; Yang, Qin UDb. Risk factors and management of pulmonary infection in elderly patients with heart failure: A retrospective analysis. Medicine 100(38):p e27238, September 24, 2021. | DOI: 10.1097/MD.0000000000027238
- Li Shen, Pardeep Jhund, Inder Anand, Ankeet Bhatt, Akshay Desai, et al.. Incidence and Outcomes of Pneumonia in Patients With Heart Failure. Journal of the American College of Cardiology, Elsevier, 2021, 77 (16), pp.1961-1973. Ff10.1016/j.jacc.2021.03.001ff. ffhal-03236565ff.