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Association Between Preexisting Heart Failure With Reduced Ejection Fraction and Fluid Administration Among Patients
Rachel E Powell1, Jason N Kennedy2,3, Mourad H Senussi4
1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
JAMA Network Open
|October 7, 2022
Summary
Patients with heart failure with reduced ejection fraction (HFrEF) received less guideline-recommended fluid resuscitation during septic shock. However, HFrEF did not significantly impact in-hospital mortality rates for these critically ill patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Sepsis Research
Background:
- Intravenous fluid administration is crucial for managing septic shock.
- Limited data exist on fluid management for septic shock patients with pre-existing heart failure with reduced ejection fraction (HFrEF).
Purpose of the Study:
- To investigate the association between HFrEF, guideline-recommended fluid resuscitation, and mortality in community-acquired sepsis and septic shock.
- To determine if HFrEF influences fluid administration and patient outcomes in septic shock.
Main Methods:
- A retrospective cohort study analyzed adult patients hospitalized with sepsis and documented HFrEF.
- Data included fluid administration within 6 hours of sepsis onset and in-hospital mortality.
- Multivariable models adjusted for sepsis severity and patient factors.
Main Results:
- Patients with septic shock and HFrEF were less likely to receive guideline-recommended fluid resuscitation (25% vs. 37%).
- HFrEF was associated with decreased odds of receiving adequate fluid resuscitation (aOR, 0.63).
- In-hospital mortality rates were similar between patients with and without HFrEF (12% vs. 13%).
Conclusions:
- Preexisting HFrEF is common in patients with septic shock.
- HFrEF is associated with reduced administration of guideline-recommended intravenous fluids.
- Despite lower fluid volumes, HFrEF did not significantly increase mortality risk in septic shock.
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