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Analysis

Guard Against Sepsis in Your Chronic Heart Failure Patients

By Christopher Cheney  
   October 22, 2018

Sepsis is particularly deadly for CHF patients, and predictors of mortality include older age and chronic obstructive pulmonary disease.

Sepsis is a primary cause of death in chronic heart failure patients, accounting for 23.5%  of deaths in a recent study.

In addition to the high sepsis mortality figure, the research in the Journal of the American Heart Association found five predictors of sepsis mortality: older age, male sex, chronic obstructive pulmonary disease, low log serum vitamin D, and high platelet count.

Targeting chronic heart failure patients with these predictors could drive down sepsis deaths among CHF patients with reduced left ventricular ejection fraction.

"Sepsis is a major contributor to death in people with CHF and has a different risk marker profile from other modes of death, suggesting that it may be amenable to targeted preventative strategies," the researchers wrote.

The sepsis predictors stand out, the researchers wrote. "Crucially, the variables most strongly associated with sepsis death showed a distinct profile compared to other noncardiovascular death, progressive heart failure, sudden cardiac death, and all-cause death."

Unexpected sepsis mortality
 

The high percentage of sepsis deaths among CHF patients was a surprising result, Richard Cubbon, PhD, a top researcher for the JAHA article, told HealthLeaders last week.

"We had not expected such a large proportion of people with heart failure to die of sepsis, but other studies have shown that sepsis is an important cause of hospitalization in people with heart failure," said Cubbon, a senior lecturer in the Leeds Institute of Cardiovascular and Metabolic Medicine at The University of Leeds, United Kingdom.

Several mechanisms could be at play for CHF patients with sepsis, he said.

"Heart failure can alter your immune response, which may increase the risk of developing infections. Some of the risk factors we identified, such as advancing age and chronic lung disease may also aggravate this phenomenon. Once infection is established, the heart must increase its pumping activity to meet the body’s increased metabolic demands—if it cannot meet these demands, vital organs receive inadequate blood supply and start to fail, which is a hallmark of sepsis."

Intervention strategies
 

The JAHA research, which featured 1,800 patients, indicates clinicians could be doing more to prevent sepsis infections such as administering influenza and pneumococcus vaccinations.

"Infection prevention strategies already exist, but they are not systematically offered to people with heart failure. So, patients and clinicians should consider the potential benefits of these strategies," Cubbon said.

Once sepsis is present in CHF patients, timely treatment is essential, he said.

"Early detection and treatment of sepsis is also known to improve survival, and so increasing awareness of the symptoms and signs of sepsis among patients and clinicians is also important. Clinicians should also be aware of the high risk of adverse outcomes when managing sepsis in people with heart failure."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


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