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. 2020 Aug 19;4(5):537-541.
doi: 10.1016/j.mayocpiqo.2020.05.008. eCollection 2020 Oct.

Improvement in Mortality With Early Fluid Bolus in Sepsis Patients With a History of Congestive Heart Failure

Andreas H Taenzer  1 , Shilpa J Patel  2   3 , Todd L Allen  4 , Martin E Doerfler  5 , Tae-Ryong Park  6 , Lucy A Savitz  7 , John G Park  8 ; Members of the High Value Healthcare Collaborative
Affiliations

Improvement in Mortality With Early Fluid Bolus in Sepsis Patients With a History of Congestive Heart Failure

Andreas H Taenzer et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To determine whether rapid administration of a crystalloid bolus of 30 mL/kg within 3 hours of presentation harms or benefits hypotensive patients with sepsis with a history of congestive heart failure (CHF).

Patients and methods: A retrospective cohort study using Medicare claims data enhanced by medical record data from members of the High Value Healthcare Collaborative from July 1, 2013, to June 30, 2015, examining patients with a history of CHF who did (fluid bundle compliant [FBC]) or did not (NFBC) receive a volume bolus of 30 mL/kg within 3 hours of presentation to the emergency department. A proportional Cox hazard model was used to evaluate the association of FBC with 1-year survival.

Results: Of the 211 patients examined, 190 were FBC and 21 were NFBC. The FBC patients had higher average hierarchical condition category scores but were otherwise similar to NFBC patients. The NFBC patients had higher adjusted in-hospital and postdischarge mortality rates. The risk-adjusted 1-year mortality rate was higher for NFBC patients (hazard ratio, 2.18; 95% CI, 1.2 to 4.0; P=.01) than for FBC patients.

Conclusion: In a retrospective claim data-based study of elderly patients with a history of CHF presenting with severe sepsis or septic shock, there is an association of improved mortality with adherence to the initial fluid resuscitation guidelines as part of the 3-hour sepsis bundle.

Keywords: CHF, congestive heart failure; CMS, Centers for Medicare & Medicaid Services; ED, emergency department; FBC, fluid bundle compliant; HCC, hierarchical condition category; HR, hazard ratio; HVHC, High Value Healthcare Collaborative; NFBC, not fluid bundle compliant; SEP-1, Sepsis CMS Core Measure.

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Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials diagram of study sample. CHF = congestive heart failure; CMS = Centers for Medicare & Medicaid Services; ED = emergency department.
Figure 2
Figure 2
Risk-adjusted mortality for initial fluid compliance among patients with heart failure with sepsis-induced hypotension. Risk-adjusted for age, sex, type of sepsis, and hierarchical condition category scores.
See this image and copyright information in PMC

References

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