Implementation of The Surviving Sepsis Campaign In Patients With Heart Failure And Sepsis. Does The Age Matter

Objective The impact of the Survival Sepsis Campaign in patients with heart failure (HF) and sepsis is unknown. Furthermore, there is limited data on the impact of age on clinically relevant outcomes in this population. Methods This retrospective cohort study included 618 patients with HF that developed sepsis. Based on age, patients were stratified into the elderly (age ≥75 years), middle-aged (55-74 years), and young adults (18-54 years). Primary outcomes included all-cause in-hospital mortality. Secondary outcomes include the development of pulmonary edema requiring interventions (diuretics vs. mechanical ventilation), cardiogenic shock, post-admission acute kidney injury (AKI), hospital length of stay (LOS), and 30-day HF-related readmission rate. Results chronic comorbidities such as coronary artery disease, hypertension, atrial fibrillation, and HF with preserved ejection fraction were more common in the elderly, while end-stage renal disease and HF with reduced ejection fraction were most likely present in young adults (See table 1).Predictors of poor outcomes such as quick sequential organ failure assessment (qSOFA) (p=0.1752), systemic inflammatory response syndrome (SIRS) (p=0.1186), and acute decompensated heart failure national registry (ADHERE) (p=0.1465) were similar among the three age groups. However, younger aged patients were most likely to have elevated NT-pro BNP, lactic acid, total bilirubin, and low albumin. The Surviving Sepsis Campaign Bundle (i.e., broad-spectrum antimicrobials and intravenous crystalloids) was equally implemented in all three age groups (p=NS). Outcomes for the elderly, middle age, and young adult population, in-hospital mortality was 33% vs. 30% vs. 24%, p=0.3881, respectively. The elderly had the lowest incidence of cardiogenic shock (p Conclusion Elderly patients with HF that develop sepsis had proportionally higher mortality (33% vs. 30% vs. 24%) despite having fewer predictors of mortality, less in-hospital complications, and shorter LOS than other age groups. These findings suggest that the generalization of the surviving sepsis campaign in patients with HF and sepsis may be deleterious. It should be individualized based on the age group.