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Background Current guidelines recommend 30cc/kg of intravenous fluid (IVF) early resuscitation for patients with suspected sepsis. However, IVF resuscitation is often delayed in patients with left ventricular dysfunction due to concern of worsening heart failure. There is limited data regarding outcomes in large volume IVF in this population with various degrees of left ventricular ejection fraction (LVEF). Methods This was a retrospective cohort study of patients with heart failure and sepsis admitted to a single cardiovascular center between January 2015 and December 2018. Heart failure was defined as preserved (EF > 50%), mid-range (40-50%), or reduced (EF Results A total of 979 patients with diagnosis of heart failure and sepsis were included in the analysis. There were 539 (55%) males and mean age was 75.4 ± 14.1. There were 590 (60.2%) patients with preserved EF, 87 (8.8%) patients with mid-range EF, and 302 (30.8%) with reduced EF. See Table 1 for baseline characteristics. There was no significant difference in amount of IVF received by either cohorts at encounter, 6 hours or 24 hours. Although not statistically significant, patients with mid-range EF appeared more likely to die during hospitalization. See Table 2 for outcomes. Conclusions This retrospective analysis suggests the mortality in patients with heart failure and sepsis was not affected by the degree of LVEF. Larger randomized trials are needed to further investigate the impact of IVF management in these patients.

Introduction Acutely decompensated heart failure (ADHF) is a complex clinical syndrome that has a heterogeneous presentation often mimicked by multiple conditions, including sepsis. There is limited data on the prevalence and factors associated with sepsis misdiagnoses in patients experiencing ADHF. Methods This is a retrospective cohort study of patients admitted to tertiary cardiovascular center with a primary diagnosis of sepsis and heart failure (chronic or newly diagnosed) between January 2015 and December 2018. Primary outcomes include the prevalence of sepsis misdiagnosis in patients with ADHF. Secondary outcomes include analysis of factors associated with sepsis misdiagnoses in patients with ADHF. Results A total of 974 patients with a diagnosis of sepsis and a history of heart failure (HF) or newly diagnosed HF admitted to our institution between January 2015, and December 2018 were included in the study. Out of the 974 patients, 536 were male with a mean age of 75±14. Sepsis was misdiagnosed in 246/974 patients with ADHF. Current clinical and laboratory criteria used to diagnose sepsis and classify its severity (i.e., tachycardia, tachypnea, leukocytosis, organ dysfunction [i.e., elevated BUN, creatinine, lactic acidosis]) were significantly abnormal in both groups (Sepsis and no-sepsis [ADHF] patients. See table for baseline characteristics. All patients (974) received early sepsis-goal directed therapy including intravenous fluid administration. Conclusions This study suggests that standard clinical and laboratory criteria use to diagnose and classified sepsis are present in patients with ADHF. Sepsis can be misdiagnosed in up to 25% of the patients with ADHF, carrying a significant treatment consequence such as aggressive fluid administration. Further studies are recommended to test this hypothesis.

Background Sepsis management in patients with heart failure (HF) is complex and challenging. Currently, there is limited data about the predictors of poor outcomes in patient with HF that are hospitalized with sepsis. Methods This is a retrospective cohort study of patients with a diagnosis of heart failure and sepsis that were hospitalized between January 2015 to December 2018. The primary outcome was overall and in-hospital mortality. Secondary outcomes predictors of poor outcomes in patients with sepsis and ADHF. Results This cohort of 1110 patients included 443/1110 (56%) men with a mean age of 75±14 (see Table I for baseline characteristics). A total of 320/1110 patients with heart failure and sepsis experienced death during the initial hospitalization. Markers of clinically relevant outcomes are listed in Table I. A logistic regression was performed for all relevant variables and demonstrated that acute kidney injury, lactic acidosis, elevated BUN, and low systolic blood pressure were strong indicators of poor outcomes in patients with heart failure and sepsis (p-value Conclusions Predictors of poor outcome among patients with sepsis and HF are crucial. Our model showed that the presence of acute kidney injury during hospitalization, low blood pressure, elevated BUN and the need for vasopressors are predicting mortality in this special population. Further studies are recommended to test this hypothesis.