Surviving Sepsis Campaign Implementation In Octogenarians And Nonagenarians With Heart Failure And Septic Shock. Implications, And Clinically Relevant Outcomes

Background With the growing aging population, the incidence and prevalence of heart failure (HF) have increased to epidemic proportions. HF patients, especially the elderly, are more prone to develop severe infections, such as sepsis. However, the clinical characteristics, management, and outcomes of octogenarians and nonagenarians with HF that develop septic shock are unknown. Methods This retrospective cohort study included 356 patients with HF and septic shock admitted to a tertiary cardiovascular center between 01/2015 and 06/2018. Age was dichotomized into ≥80 years [octogenarians (80-89) and nonagenarians (90-99)] and Results Out of the 365 patients with HF and septic shock, 157(44%) were ≥80 years of age (octogenarians and nonagenarians), and the remainder were Outcomes In-hospital mortality was significantly higher for octogenarians and nonagenarians 61% (95/157) vs 45% (89/199) p=0.0053. Furthermore, the implementations of the Surviving Sepsis Campaign bundle (30ml/kg bolus of intravenous crystalloids) was more likely to cause pulmonary edema requiring intravenous diuresis in patients Conclusion Octogenarians and nonagenarians with heart failure and septic shock have significantly higher mortality than other age groups despite the similar implementation of the Surviving Sepsis Campaign. A tailored protocol that addresses the specific characteristics of this population is urgently needed.