Study: Sepsis Increases Risk of Heart Failure, Rehospitalization After Hospital Discharge

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Patients with sepsis were 27% more likely to die, 38% more likely to be rehospitalized for any cause, and 43% more likely to return to the hospital specifically for cardiovascular causes.

Patients who were discharged after a hospitalization involving sepsis had a greater risk of cardiovascular events, rehospitalization for any cause, or death during a maximum follow-up of 12 years, according to a new study published in the Journal of the American Heart Association.

Sepsis is a leading cause of hospitalization and death globally, according to the investigators. Each year in the United States, approximately 1.7 million patients develop sepsis, which is an extreme immune response to an infection in the bloodstream that can spread throughout the whole body and lead to organ failure and possibly death.

“We know that infection may be a potential trigger for myocardial infarction or heart attack, and infection may also predispose a patient to other cardiovascular events, either directly during infection or later when the infection and related effects on the body promote progressive cardiovascular disease,” said lead study author Jacob C. Jentzer, MD, FAHA, in a press release. “We sought to describe the association between sepsis during hospitalization and subsequent death and rehospitalization among a large group of adults.”

In the study, investigators examined whether adults who had sepsis may have a higher risk of death and rehospitalization for cardiovascular events after discharge. They used a database containing administrative claims data and identified more than 2 million enrollees of commercial and Medicare Advantage insurance across the United States who survived a non-surgical hospitalization of 2 nights or more between 2009 and 2019.

Those patients ranged between 19 and 87 years of age, and the medical claims indicated that more than 800,000 patients had sepsis during their hospital stay. The investigators analyzed the association of hospitalization with sepsis, rehospitalization, and death over a follow-up period from 2009 to 2021.

Because variations in sepsis diagnosis and documentation can impact outcomes in research and clinical treatment, the researchers used both explicit and implicit diagnosis codes. Explicit sepsis means a physician formally diagnosed the patient, whereas implicit sepsis is an administrative code in the electronic health record given automatically when a patient has both an infection and organ failure.

To focus on the potential cardiovascular impact of sepsis, the researchers compared 808,673 hospitalized patients who had sepsis with 1,449,821 hospitalized patients who did not develop sepsis but still had cardiovascular disease or 1 or more cardiovascular disease risk factors.

According to the study, patients with sepsis were 27% more likely to die, 38% more likely to be rehospitalized for any cause, and 43% more likely to return to the hospital specifically for cardiovascular causes in the 12 years after having sepsis. Heart failure was the most common major cardiovascular event among patients who had sepsis, and those who had sepsis had a 51% higher risk of developing heart failure during the follow-up period.

Furthermore, patients with implicit sepsis had a 2-fold increased risk of rehospitalization for cardiovascular events compared to those with explicit sepsis.

“Our findings indicate that after hospitalization with sepsis, close follow-up care is important, and it may be valuable to implement cardiovascular prevention therapies with close supervision,” Jentzer said in the press release. “Professionals need to be aware that people who have previously had sepsis are at very high risk for cardiovascular events, and that it may be necessary to advise them to increase the intensity of their cardiovascular prevention.”

The study authors plan to continue evaluating new data on individuals who have previously had sepsis during hospitalization in order to map out their needs for cardiovascular prevention therapies, according to the press release.

“It’s an important opportunity to establish what might and might not work in the future for people who have had sepsis,” Jentzer said in the press release.

REFERENCE

Sepsis increased risk of heart failure and rehospitalization after hospital discharge. News release. American Heart Association; February 1, 2023. Accessed February 7, 2023. https://newsroom.heart.org/news/sepsis-increased-risk-of-heart-failure-and-rehospitalization-after-hospital-discharge?preview=6421

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