Prevalence and Predictors of Sepsis Death in Patients With Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction

Abstract

Background Noncardiovascular death is increasingly common in people with chronic heart failure ( CHF ), yet its causes remain poorly characterized. We aimed to define the prevalence of sepsis death in people with CHF and to ascertain its risk marker profile. Methods and Results We conducted a prospective cohort study of 1802 patients with CHF and left ventricular ejection fraction ≤45% attending CHF clinics in 4 United Kingdom hospitals between 2006 and 2014. Mode of death was defined over a 10.3‐year follow‐up period (mean 4 years). Competing risk regression defined mode‐specific hazard ratios for sepsis, other noncardiovascular, progressive heart failure, and sudden cardiac death in relation to established heart failure prognostic markers. Of 737 deaths, 173 (23.5%) were due to sepsis; respiratory tract infections accounted for 69.9% (n=121) of these events. Those who died from sepsis were older, had higher platelet counts, and had a higher prevalence of chronic obstructive pulmonary disease than those who died from other causes. Sepsis death was independently associated with older age (hazard ratio=1.05; 95% confidence interval 1.03‐1.07), greater prevalence of chronic obstructive pulmonary disease (2.43; 1.74‐3.40), male sex (1.73; 1.16‐2.60), lower log serum vitamin D (0.68; 0.49‐0.95), and higher platelet count (1.002; 1.000‐1.005) than nonsepsis death. Established heart failure prognostic markers exhibited different patterns of association with sepsis death, other noncardiovascular death, progressive heart failure death, and sudden cardiac death. Conclusions Sepsis is a major contributor to death in people with CHF and has a different risk marker profile from other modes of death, suggesting that it may be amenable to targeted preventative strategies.

Racial differences in the association of NT-proBNP with risk of incident heart failure in REGARDS

“…The predictive ability of NT-proBNP and other covariates for incident HF in each BMI and eGFR category by race was further assessed using Wald's test statistics (50). The relative importance of NT-proBNP and other covariates for predicting incident HF across BMI and eGFR categories with corrected degrees of freedom allocated to each covariate was depicted by ranking the percentage contribution of the variable-specific Wald's test out of the global Wald χ 2 score (i.e., Wald statistics) (51). Ranking of the percentage contribution of log 2 NT-proBNP and other variables in the final model was calculated using the following formula: (the χ 2 score of the predictor variable/the global χ 2 score) × 100.…”

Futility in cardiology: the need for a change in perspectives: reply

“…Non-cardiovascular causes account for approximately half of all deaths in patients with HF. 5 Therefore, as attractive a more detailed assessment of the cardiovascular system seems, it can never encompass the status of today's multi-morbid patients.…”

“…However, we counter the claim that this assessment is truly ‘holistic’ since focusing on physiology cannot account for frailty, performance status, or the ‘end‐of‐the‐bed’ assessment that the Surprise Question inevitably encompasses. Non‐cardiovascular causes account for approximately half of all deaths in patients with HF . Therefore, as attractive a more detailed assessment of the cardiovascular system seems, it can never encompass the status of today's multi‐morbid patients.…”

Anaerobic Bacteremias in Left Ventricular Assist Devices and Advanced Heart Failure

“…Patients affected with heart failure have improved survival rates thanks to advances in its medical management [1][2][3]. For individuals who face a high short-term mortality risk and scarce chances of receiving a transplant, left ventricular assist devices (LVAD) have continued to be a therapeutic option [4].…”

“…ere is an increase in the noncardiovascular causes of mortality within this population [9]. Infections represent an important emerging clinical problem leading to decompensation of heart failure (HF) and sepsis [1,9,10]. Infections remain a complicating factor of LVAD therapy and HF, with reported rates ranging from 30 to 50% [11,12].…”