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Introduction: The use of aggressive fluid therapy in patients with heart failure and reduced ejection fraction (HFrEF) who develop septic shock is controversial. Methods: This is a retrospective cohort study of 334 patients with heart failure (HF) and septic shock admitted to a tertiary cardiovascular center between 01/2015 and 06/2018. For this study, ejection fraction (EF) was dichotomized into <45% (HFrEF) and ≥45% (HF with preserved EF). The evaluated outcomes included in-hospital mortality, development of pulmonary edema, cardiogenic shock, and 30-day readmission rate. Results: A total of 133(40%) patients had HFrEF, and 201(60%) patients had HFpEF (see Table 1, baseline characteristics). Early goal direct fluid therapy and vasopressors were equally implemented in all patients with HF that developed septic shock. Outcomes: There was no difference in in-hospital mortality for patients with HFrEF that developed septic shock when compared to patients with HFpEF, 64(48%) vs 102(51%) p=0.6542. Patients with HFrEF had a higher incidence of cardiogenic shock 25(19%) vs 9(4.5%) p<0.0001 and 30-day HF-related readmission 25(36%) vs 17(17%) p=0.0096. However, pulmonary edema requiring urgent intravenous diuresis 82(62%) vs 113(56%) p=0.4186 or mechanical ventilation 70(53%) vs 110(55%) p= 0.6543 was similar between groups. Conclusions: Once patients with HF develop septic shock, the mortality is similar for both HFrEF and HFpEF. However, complications such as cardiogenic shock and 30-day readmission are more common in patients with HFrEF. A more individualized treatment approach is needed for this population.

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