Increased Risk of Post-Discharge CVD Events Among Survivors of Sepsis
Sepsis is one of the leading causes of hospitalizations worldwide. Potentially deadly infections like sepsis can prompt myocardial infarction among hospitalized patients or lead to other cardiovascular events among post-discharge patients.
Although previous studies have examined the association between sepsis and the risk among patients with post-discharge cardiovascular events, high-quality evidence supporting this association is still needed.
In a recent retrospective cohort analysis, researchers set out to determine whether adults who had sepsis may have a higher risk of death or a higher risk of rehospitalization for post-discharge cardiovascular events than individuals hospitalized without sepsis.
The researchers found that, after accounting for preexisting cardiovascular disease and acute organ failure during hospitalization, patients either hospitalized with sepsis or who developed it while hospitalized had a higher risk of rehospitalization for cardiovascular causes (43%) compared with those hospitalized and without sepsis.
To discuss the implications of these results and how it impacts a broad range of specialists, Consultant360 spoke with the lead author of the study, Jacob C. Jentzer, MD, Assistant Professor of Medicine in the Department of Cardiovascular Medicine at the Mayo Clinic in Rochester, Minnesota.
Consultant360: How do your study results fill a current gap in our knowledge?
Jacob C. Jentzer, MD: This analysis clarifies the association between sepsis during hospitalization and an increased risk of subsequent cardiovascular events and death. All definitions of sepsis were associated with a higher risk of both atherosclerotic and non-atherosclerotic post-discharge cardiovascular events, particularly hospitalization for heart failure. This excess risk was above and beyond the risk attributable to pre-existing cardiovascular disease or cardiac risk factors, as the study population was purposefully enriched in high-risk patients.
Consultant360: Considering prior studies have researched the relationship between sepsis and post-discharge cardiovascular events, why the need to clarify the association?
Dr Jenzter: In our opinion (supported by a recent meta-analysis of prior studies), the published literature regarding the risk of cardiovascular events in sepsis survivors has some limitations. Specifically, many prior studies have either had a low-risk comparator groups (which could have overinflated estimates of the risk associated with sepsis) or only focused on some rather than all relevant cardiovascular events. We believe that our study, which included a high-risk non-sepsis comparator group and examined the entire spectrum of cardiovascular events, expands on this prior literature.
Consultant360: What are the knowledge gaps that still remain following the publication of this study?
Dr Jenzter: The most pressing research need is to determine what (if any) medications or non-pharmacological interventions can be added or escalated after hospitalization for sepsis to reduce the risk of subsequent cardiovascular events.
Consultant360: What kind of research can fill those remaining gaps?
Dr Jenzter: The best way to address this would be with a clinical trial examining add-on cardiovascular prevention therapy, such as statins or ACE inhibitors, for sepsis survivors without established cardiovascular disease (who had a greater relative increase in risk than those with pre-existing cardiovascular disease, despite a lower absolute risk). But in the meantime, well-constructed observational comparative effectiveness studies may provide insights about which therapies are worth further examination.
Consultant360: How does this study impact other specialists? Which ones and why?
Dr Jenzter: The findings of this study are applicable to a broad range of clinicians caring for sepsis survivors during and after hospitalization. While the potential relevance for cardiologists may be clear based on the possibility that sepsis may be a novel cardiovascular risk factor, primary care physicians and hospitalists commonly encounter patients with sepsis during and after hospitalization. It is essential for all providers to understand the elevated cardiovascular risk among sepsis survivors to ensure that cardiovascular preventive therapies are continued after hospitalization (or added when indicated).
Reference: Jentzer JC, Lawler PR, Van Houten HK, Yao X, Kashani KB, Dunlay SM. Cardiovascular events among survivors of sepsis hospitalization: a retrospective cohort analysis. J Am Heart Assoc. 2023:12(3):e027813. doi:10.1161/JAHA.122.027813.