Implementation of the Surviving Sepsis Campaign in Patients With Heart Failure: Gender-Specific Outcomes

<p> <h4> Background </h4></p><p> Limited data exist about the impact of gender-specific outcomes in patients with heart failure (HF) who develop concomitant sepsis. <h4> Methods </h4></p><p> This is a retrospective cohort study of patients with HF who developed sepsis. Clinical outcomes, including in-hospital mortality, development of cardiogenic shock (CS), pulmonary edema requiring urgent intravenous diuretics (IVD), acute kidney injury (AKI), length of stay (LOS), and 30-day HF-related readmission, were evaluated in men vs. women. <h4> Results </h4></p><p> This cohort of 618 patients includes 272 (44%) women with a mean age of 75&plusmn;14 years. Coronary artery disease (p&lt;0.0001), diabetes mellitus (p=0.0213), stage &ge; 3 chronic kidney disease (p&lt;0.0001), and HF with reduced ejection fraction (HFrEF) (p=0.0015) were more prevalent in men. The implementation of the Surviving Sepsis Campaign (i.e., intravenous (IV) crystalloids in the first six hours) was more aggressive in women (p=0.0192). There was no difference in in-hospital mortality (p=0.2385) between men and women. After adjusting for HF types, women with HF with preserved ejection fraction (HFpEF) developed more episodes of pulmonary edema requiring urgent IVD (p=0.0389), while men with HFpEF had more CS requiring inotropes (p=0.0400) and a longer LOS (p=0.0434). Conversely, women with HFrEF were most likely to develop CS requiring inotropes (p=0.0132). <h4> Conclusion </h4></p><p> Women with HF who developed sepsis receive a more aggressive implementation of the Surviving Sepsis Campaign than men, leading to more pulmonary edema events in women with HFpEF and more cardiogenic shock in women with HFrEF. A cautiously tailored approach is desperately needed for patients with HF who develop sepsis.</p>