(1594) Hypertrophic Obstructive Cardiomyopathy and Sepsis: A Nationwide Comparison With Heart Failure

Introduction: Retrospective analyses show higher complications and mortality rates in heart failure (HF) patients with sepsis when compared to patients without HF. Notably, patients with heart failure with reduced ejection fraction (HFrEF) fare worse than those with preserved ejection fraction (HFpEF) when admitted for sepsis. The impact of hypertrophic obstructive cardiomyopathy (HOCM) on sepsis outcomes remains unexplored. This comparative retrospective study aims to address this gap by analyzing the NIS database to determine how HOCM patients with sepsis compare to patients with HF subtypes. It was hypothesized that HOCM patients would have similar outcomes to patients with HFpEF.

Methods: This retrospective study used patient records from the 2019-2020 National Inpatient Database (NIS). We identified patients admitted with a primary diagnosis of sepsis who also had a history of HFpEF, HFrEF, or HOCM using International Classification of Diseases-10 (ICD-10) codes. We utilized the chi-square test to compare baseline characteristics between our populations with HFpEF vs HFrEF vs HOCM. Z tests were performed to compare mortality rates between HFpEF, HFrEF and HOCM patients.

Results: This study included 336,887 patients with a primary diagnosis of sepsis. Of these, 29,788 had HFrEF, 35,684 had HFpEF, and 244 had HOCM. On average, patients with sepsis and HFpEF (74.2 years, CI: 73.9 - 74.4) were older than patients with HFrEF (70.9 years, CI: 70.97 - 71.41) and HOCM (69.66 years, 67.83 - 71.49). The proportion of septic patients with concomitant HFrEF who died (z value= 19.3, p value= 0.00001) was significantly greater than HFpEF (z value= 2.6, p value= 0.11) and HOCM (z value= .0089, p value= 0.92) respectively. There was no significant difference in mortality rates between HFpEF and HOCM.

Conclusions: When admitted for the treatment of sepsis, patients with HOCM had similar outcomes to patients with HFpEF, both of which had improved mortality rates compared to patients with HFrEF. These findings provide crucial insights to help the clinician stratify risk amongst critically ill patients with sepsis and cardiovascular disease.