Comparison of Outcomes of Patients with Acute Exacerbation of Heart Failure with versus without Sepsis: Nationwide Study from 2007-14

Abstract

Purpose This study explores the impact of severe sepsis and septic shock on morbidity, mortality and length of stay in patients admitted to the hospital with a primary diagnosis of heart failure in acute exacerbation. Methods We examined National Inpatient Sample (NIS) database from years 2007-14 for all hospital admissions with heart failure admitted with acute exacerbation with vs without sepsis. ICD9 codes were utilized for selecting the study group. We compared baseline characteristics of the two groups using parametric and non-parametric tests for continuous variables and Chi-Squares test for dichotomous variables. Multivariate logistic regression was used to draw comparisons between incidence of cardiogenic shock, in-hospital mortality and length of stay (LOS). Our analysis adjusted for age, sex, race, payer, income quartiles, hospital location, region, size and teaching status. Comorbidities in charlson comorbidity Index were accounted for in our analysis. Missing values for covariates in the regression analysis were adjusted by using multivariate imputation by chained equations technique to ensure valid statistical inference. Results From 2007-2014, a total of 7,000,805 patients were included in the aforementioned study group. 1.08% (75,765) of the study population had concomitant diagnosis of Sepsis. Study population did not significantly differ in age (mean age 72.8 yrs. (HF)vs 71.4 yrs. (HF w Sepsis) p>0.05).HF with sepsis group were more likely to be males (p Conclusion This nation-wide study indicates that concomitant sepsis in patients admitted for heart failure exacerbation significantly increases morbidity and mortality in terms of cardiogenic shock and longer length of stay.