Sepsis can increase the risk of heart failure and rehospitalization after hospital discharge. Sepsis is a severe and life-threatening condition that occurs when the body’s response to an infection damages its own tissues and organs. This can lead to a number of complications, including heart failure, which occurs when the heart is unable to pump enough blood to meet the body’s needs. Rehospitalization after discharge can also occur if the sepsis has not been fully treated or if the patient experiences complications or infections related to the initial episode of sepsis. It is important for patients with sepsis to receive prompt and appropriate treatment, as well as close monitoring and follow-up care after discharge, to reduce their risk of heart failure and rehospitalization.
A new study discovered that people who were hospitalized for sepsis or who developed it while in the hospital had an increased risk of heart failure or rehospitalization within 12 years.
According to new research in the Journal of the American Heart Association, people who were discharged from a hospitalization involving sepsis had a higher risk of cardiovascular events, rehospitalization for any cause, or death over a maximum follow-up of 12 years compared to those who were hospitalized but did not have sepsis.
Sepsis is a leading cause of hospitalization and death worldwide. Each year in the U.S., about 1.7 million people develop sepsis, 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.
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.
Jacob C. Jentzer
“We know that infection is 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, M.D., FAHA, an assistant professor of medicine in the department of cardiovascular medicine at the Mayo Clinic in Rochester, Minnesota. “Our goal was to describe the relationship between sepsis during hospitalization and subsequent death and rehospitalization in a large group of adults.”
Researchers looked into whether adults with sepsis had a higher risk of death and rehospitalization for cardiovascular events after being discharged from the hospital. They searched a database of administrative claims data and found more than 2 million commercial and Medicare Advantage insurance enrollees in the United States who survived a non-surgical hospitalization of two nights or more between 2009 and 2019. More than 800,000 of these patients, aged 19 to 87, had sepsis during their hospital stay, according to medical claims. The researchers looked at the link between hospitalization and sepsis, rehospitalization, and death from 2009 to 2021.
Because variations in sepsis diagnosis and documentation can affect research and clinical treatment outcomes, researchers included two standard sepsis diagnosis codes: explicit and implicit. A physician has formally diagnosed the patient with explicit sepsis. Implicit sepsis is a code in the electronic health record that is automatically assigned when a patient has both an infection and organ failure, which is the currently accepted definition of sepsis. Patients were classified as having sepsis or not having sepsis based on the presence of either definition of sepsis.
To examine the potential cardiovascular impact of sepsis, researchers compared 808,673 hospitalized patients who had sepsis to 1,449,821 hospitalized patients who did not develop sepsis but had cardiovascular disease or one or more cardiovascular disease risk factors (older age, hypertension, hyperlipidemia, type 2 diabetes, chronic kidney disease, obesity or smoking).
The analysis found:
- When compared to patients who did not have sepsis during their hospital stay, those who had sepsis were 27% more likely to die, 38% more likely to be re-hospitalized for any reason, and 43% more likely to be re-hospitalized specifically for cardiovascular causes in the 12 years following sepsis.
- The most common major cardiovascular event (including stroke, heart attack, arrhythmia, and heart failure) among people with sepsis was heart failure. People who developed sepsis while in the hospital had a 51% increased risk of developing heart failure during the follow-up period.
- Patients with implicit sepsis (infection with organ failure) had a two-fold increased risk of rehospitalization for cardiovascular events compared to those with explicit sepsis (formal diagnosis by a physician).
“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. “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 researchers plan to continue evaluating new data on people who have previously had sepsis while hospitalized in order to map out their needs for cardiovascular prevention therapies. “It’s a critical opportunity to determine what may or may not work in the future for people who have had sepsis,” Jentzer said.
The study’s main limitation is that it is a retrospective cohort study that relies on data gathered through hospital administration. This meant that researchers were analyzing historical data and lacked information on the severity of sepsis.
