Sepsis Bundle Compliance & IV Fluids Associated With Lower Mortality in Patients With Heart Failure

Introduction: Sepsis is one of the leading causes of death among hospitalized adult patients. Timely administration of broad-spectrum intravenous (IV) antibiotics and fluids improves outcomes in sepsis. However, in patients with heart failure (HF), and those with volume overload in particular, it is unclear whether there is benefit, or potential harm, from fluid resuscitation.


Methods: We identified adult patients admitted to Michigan Medicine from 8/11/2021 to 7/31/2025 who either presented with sepsis or were diagnosed with sepsis during their hospitalization and had a coexisting diagnosis of HF during their admission. Patients were retrospectively identified as having sepsis either by ICD-10 code or by meeting Center for Disease Control Acute Sepsis Event criteria: (1) blood cultures collected, (2) evidence of end-organ dysfunction, and (3) receipt of at least 4 days of qualifying antibiotics. Patients were identified as having HF by any ICD-10 code that included “heart failure.” Subgroups were identified by any ICD-10 code that included acute (AHF), systolic (SHF), or both acute and systolic (ASHF). Sepsis bundle compliance was defined as collection of blood cultures, measurement of lactate, administration of IV antibiotics, and administration of IV fluids (if eligible by either systolic blood pressure < 90 mmHg or lactate >4 mmol/L) within 3 hours of sepsis onset. Data collected included baseline demographics, sepsis bundle element compliance, hospital length of stay, and in-hospital mortality.


Results: We identified 4307 patients with sepsis and HF. Among those, 1498 had AHF, 2160 had SHF, and 940 had ASHF. 1903 patients were considered eligible for IV fluids. In all groups, both 3-hour bundle compliance (All HF: 12.2% vs 19.3%, p< 0.01; AHF: 15.6% vs 24.3%, p< 0.01; SHF: 13.7% vs 19.9%, p< 0.01; ASHF: 17.5% vs 25.7%, p=0.03) and IV fluid compliance (All HF: 18.6% vs 25.7%, p< 0.01; AHF: 21.2% vs 28.6%, p=0.03; SHF: 18.3% vs 24.5%, p=0.01; ASHF: 23.0% vs 28.5%, p=0.18) were associated with improved mortality.


Conclusions: Among patients with sepsis and HF, both sepsis bundle and IV fluid compliance were associated with improved mortality. Improvements in mortality were seen in multiple subgroups of HF. This study was limited by a retrospective single-center design.