Transcripts are auto-generated and may contain errors.

Dr. Mitchell Elkind: [00:00:00] I think about a third of people will have some cardiovascular event while they’re hospitalized. Uh, and uh, some people have said that atrial fibrillation alone may occur in as much as 40% or so of patients with sepsis. 

Nicole Kupchik: That is a stat actually, I did not know. 

Dr. Mitchell Elkind: Yeah, that is a crazy stat 

Nicole Kupchik: if you think about it.

For up to 40%. 

Dr. Mitchell Elkind: Yeah. 

Nicole Kupchik: This is the sepsis spectrum, a podcast about antimicrobial resistance, sepsis, and how to expect the unexpected in your practice.

[sponsor message]: Sepsis Alliance gratefully acknowledges the monetary support provided by Vantive for this podcast series. 

Mary Millard: My name is Mary Millard and I live in the Baton Rouge area of Louisiana, and I’m a retired nurse, uh, being forced to retire. Uh, kind of what happened to me. I went into the hospital in 2014 and they found a large aneurysm, uh, on my aorta [00:01:00] at the base of my heart.

It had partially collapsed my valve. Three days later, a day before the surgery, I went to an, uh, cardiac arrest, full arrest. They could not bring me with, uh, back with the paddles three times. I had a six minute and 45 second code. And after that they decided to do ecmo. It’s a, uh, machine and it circulates and oxygenates your blood for you.

I was on ECMO for about a week. My own heart started coming back after they cleared it. I had been weakened quite a bit. And, uh, they did the surgery. They told me You’re gonna go home in about 10 days and everything will be fine. Later, I was put into, step down and, uh, my husband said he came into the room and he found me with my head hanging down, burning up, and I was talking and coherently, and this is, uh, where it went a little bit wrong.

The nurse did [00:02:00] not come in and assess me. They sent me to, uh, neurology to get a workup, and I was in neurology for seven hours. And, uh, there’s a note at the end of, uh, the neurologist, uh, assessment that said possibly sepsis. It was a very hard journey. I’ve also had to, uh, get a, uh, internal pacemaker because the oxidative stress from that sepsis, uh, hardened the heart and it has a hard time beating.

I’m told I can never get a transplant because I have all kinds of artificial plumbing. There and, uh, I suffer from PTSD. Every time I go into a hospital, I smell those gowns. I smell the tubing, and I just shut down. I just wanna let people know that, um, hospital acquired infections kills a lot of people, and one in 25 is a lot of people, and we need prevention.

To help prevent sepsis.

Nicole Kupchik: Hi everyone, and welcome [00:03:00] to the sepsis spectrum. I’m Nicole Kupchik, critical care nurse, clinical nurse specialist, and your guide to the wide, unpredictable world of sepsis, or as we like to call this season sepsis and multiorgan dysfunction syndrome. On today’s episode, we’re gonna examine the relationship between sepsis and cardiovascular.

Injury, specifically how infection can overwhelm the very system that keeps our organs alive. We just heard from Mary Millard, a Sepsis survivor who went in for heart surgery and as one setback led to another, experienced firsthand how sepsis can become the first domino in a devastating life altering chain of events.

Mary’s testimonial is an all too familiar one. I think it really hammers home that sepsis doesn’t just lower the blood pressure or come and go. It leaves its mark. It disrupts the entire network of vessels, valves, and [00:04:00] electrical rhythms that keeps the body in motion. And yes, the heart can survive the arrest, but what often remains is a chronic struggle with weakened organs and the long shadow of invasive care.

The heart is built to endure, but in sepsis, even that resilience is tested, blood vessels lose tone. The heart weakens and inflammation sets the stage for long-term damage. Joining me today is Dr. Mitchell Elkind, chief Science Officer for Brain Health and Stroke at the American Heart Association. Dr. Elkind is a vascular and stroke neurologist whose research explores how infection and inflammation disrupt the cardiovascular system from the acute risk of heart attack, stroke, and atrial fibrillation, to the lasting vascular changes that raise risk long after recovery.

Together we look at how sepsis leaves its mark on a heart why survivors face persistent [00:05:00] cardiovascular risk, and what true recovery means once the crisis has passed. We’ll be right back with Dr. Mitchell Elkind.

I am so excited to welcome to the show, Dr. Mitchell Elkind. So welcome Dr. Elkind. 

Dr. Mitchell Elkind: Thank you so much, Nicole. Delighted to be here. 

Nicole Kupchik: Yeah. So you’re working on some pretty amazing things at the American Heart Association. Can you kind of fill us in on what’s going on? 

Dr. Mitchell Elkind: Of course. So, uh, I’m the Chief Science Officer for Brain Health and Stroke at the American Heart Association.

And as you may know, the American Heart Association has just celebrated 100 years. We just had our hundredth birthday. And, uh, we’re moving on to think about what we’re gonna do in the next century. And we’re, um, focusing among many other things on the brain. So certainly we’ve done stroke for a long time, but now we’re looking into other aspects of [00:06:00] brain health as well, like cognitive aging and dementia and other neurological conditions too.

And we’re also super interested in the connection between the rest of the body and the brain. And I think sepsis is a perfect example of how that happens. 

Nicole Kupchik: That, that’s really exciting actually to hear where kind of research is gonna be driven next. So, all right, so we’re talking about a very complex subject today.

We’re talking about sepsis, and we both know that sepsis has profound effects on the body. Both in the acute phase, but also in the recovery phase. And so one of the things I wanted to chat about today, so let’s say we’ve got a patient who survived sepsis, septic shock delirium i’s just pile it all on and now they’re getting discharged, they’re going home or maybe to a rehab facility.

What types of things do patients now have to deal with once they’re in the recovery phase of [00:07:00] sepsis? A neurologic standpoint. 

Dr. Mitchell Elkind: Well, from a neurologic and a cardiovascular standpoint, um, we think about the effects of sepsis on a person as happening. Uh, at least I think of it as happening in kind of three different time periods, or EC if you will.

You know, there’s what happens acutely to the heart and the brain when somebody’s. In the hospital, and particularly in the, you know, throes of being in the intensive care unit, the most acute phase, there’s things that can happen to the heart and the brain in that setting. And then, uh, over the kind of short term, maybe weeks.

To perhaps even months after that acute event. There’s some long lasting effects of the sepsis that can lead to cardiovascular and neurological problems. And then there’s even a long-term phase going out months to years, many years even suggesting that sepsis can have long-term consequences. So I think, [00:08:00] um, what we want to begin to think about is how we prepare to.

Uh, manage the person over the long term after an episode of sepsis. You know, for example, if there’s an increased risk of cardiovascular events like heart attacks or strokes, what can we do for people to try to prevent those from happening? 

Nicole Kupchik: And I think we’ve seen so many times, even while patients are hospitalized from a cardiovascular standpoint, we’ll see cardiac dysfunction.

We even see a traditionally non-cardiac patient go into atrial fibrillation. So long-term, does that same patient have those risks? 

Dr. Mitchell Elkind: They do. They do. A lot of the, uh, epidemiological literature suggests that there’s a risk. Of heart attacks and strokes and heart failure that continues for months to years after the acute event.

And as you [00:09:00] said, that can happen even in people who don’t have a previous history of heart disease. I think many of us. Have this idea that when somebody who has a known, you know, history of heart failure, or they have, uh, cerebrovascular disease or maybe dementia, that they’re at elevated risk of having complications when they have sepsis.

And that’s certainly true, but you don’t have to have those predisposing conditions or preexisting conditions in order to suffer the consequences, the long term consequences of sepsis. And in fact, in, uh, some of the. Epidemiological work that, that we’ve done at Columbia University. For example, we’ve found that some of these, uh, effects of sepsis is a risk factor for long-term stroke risk.

Uh, actually suggest that people who are younger. Tend to have a higher risk than people who are older. Um, it may be a reflection of the fact that older people have lots of other reasons [00:10:00] to have these cardiovascular events. So the specific impact of having a septic event and being hospitalized with sepsis are less.

Um, and so the, the, uh, impact of the sepsis itself tends to have a longer effect. I also think people don’t realize that, you know, we, we all have this idea that when you have an acute episode of sepsis, the inflammatory measures, you know, the cytokines, uh, go up acutely. And certainly they do, and they can go up to, you know, extremely high levels.

And then we expect that as a person recovers. Those go back down. And they do, but they don’t necessarily go back down to normal. They actually remain elevated for a long period after sepsis. And they, uh, m even remain elevated for, for months to years afterwards. So a severe infection can lead to long term inflammatory and, and other complications.

Nicole Kupchik: So when we get down to the root of like what [00:11:00] is causing all these long-term effects, so we know inflammation. Plays a huge part. What else lends to the long-term effects that we’re seeing with, 

Dr. Mitchell Elkind: yeah, so, um. There’s probably, uh, a number of different things that happen and, uh, inflammation we know is tightly linked to the clotting system.

The coagulation system of the body, right? So we talk now about this phenomenon of. Thrombo inflammation, recognizing the links between inflammation and blood clotting. And this became very much more recognized during the COVID pandemic when we saw in many, many patients who were, you know, severely illac, acutely with COVID, that they could develop this, uh, thrombo inflammatory phenomenon.

They would develop blood clots. I mean, certainly I took care of even young people who had no good reason to have, uh. Bad clotting disorders or strokes. They would come in [00:12:00] sometimes with mild cases of COVID, and yet they would have large blood clots in the carotid artery or the arteries in the brain, or even in the heart.

And so, um, the same phenomenon can occur in people after sepsis of other causes too. It’s not limited to only COVID. We just saw a lot of it, which is why we became so aware of it at that time. And so. Blood clotting, coagulopathy, uh, primarily thrombosis, but even in some cases, hemorrhage can be an important consequence of that kind of inflammation.

But there are other mechanisms too. Uh, inflammation can contribute to. Atherosclerosis, you know, a formation in, uh, the blood vessels, whether it’s the coronary arteries, the carotid arteries, or the aorta and other blood vessels. Um, the inflammatory process plays an important role. The development [00:13:00] of atherosclerosis.

You know, in the old days we used to think of hardening of the arteries as being primarily a lipid driven process. You know, that you would deposit cholesterol in the blood vessels and they would thicken over time. But we understand now that a lot of that process is really driven by inflammation, and it may be.

In part due to reaction against, uh, oxidized lipid particles, but it can also be a reaction against other, um. Stimulants, including potentially infectious agents. And so that can lead to thickening of the arteries. And, uh, you know, again, um, risk of stroke and, and heart attacks over time and animal models have have shown this as well.

So you can induce at the aroma in the aorta of animals. Exposing them to certain severe infectious, uh, [00:14:00] agents. And so, uh, there’s good evidence from the epidemiology side as well as the kind of mechanistic, uh, experimental side that this sort of phenomenon occurs. We don’t quite know exactly what to do about it yet, but we do think that happens.

Nicole Kupchik: And do you feel that perhaps like statins can play a role or maybe even like metformin or the GLP one drugs, do you do, is there a role for any of these medications? 

Dr. Mitchell Elkind: Well, we don’t know the answer to that yet. So currently the way that we think about a long-term prevention of cardiovascular events, right, is to do a, uh, a calculation of somebody’s risk.

Primary care doctors, for example, supposed to use a risk prediction tool or algorithm. The American Heart Association has a new one now called the Prevent Risk Calculator that accounts for your blood pressure, your blood sugar, your history of, you know, diabetes and family history and so forth. And you [00:15:00] can find these, uh, calculators online and then you can estimate somebody’s long-term risk and if their risk is above a certain threshold.

Then you would begin them on statin therapy, not just because they have an increase in cholesterol, for example, but because their overall risk is high enough. And one really important question in my mind is whether a history of sepsis should be considered a risk factor, like. A history of diabetes or a history of hypertension.

We don’t have the answer to that question yet though. Um, and so, you know, the risk calculators don’t yet include a history of sepsis, for example, but the observational data would suggest. That in fact, people who do have a history of sepsis probably are at higher risk. And I think we’re just at the point now where the research is starting to look into that question.

You know, do we ca do we include [00:16:00] history of sepsis as part of our risk, uh, as estimation for the future long-term risk in people? 

Nicole Kupchik: Yeah, because I mean, so many of these patients get discharged and it’s like discharged to who, right? Their primary care provider who, how do you even, like, how do you identify who that high risk patient is?

Right? So do you know of any programs where they’re measuring inflammatory markers or things like that once a patient gets discharged after having sepsis? 

Dr. Mitchell Elkind: Well, we don’t have any programs that I’m aware of that do that yet because the research kind of hasn’t risen to that level. Um, we do know from, from certain clinical trials though, uh, in patients with cardiovascular disease that elevated levels of, uh, certain inflammatory markers like C-reactive protein, and, uh, IL six.

Uh, can be beneficial in, in predicting risk, especially in people who don’t have [00:17:00] other risk factors for cardiovascular events. And we know that certain, um, agents, certain drugs that target the immune system, can actually help to prevent cardiovascular events. So, for example, can Kinumab, which is an, uh, monoclonal antibody directed against the IL one receptor, can have an, uh.

An effect on reducing the risk of cardiova future cardiovascular events in people who’ve already had a first mi, um, or heart attack, for example. And similarly, colchicine, another inflamm anti-inflammatory agent, seems to have some benefit in reducing future risk. So whether we should be giving, you know, those drugs or statins to people with an initial septic event, even if they don’t have.

Um, high cholesterol, let’s say, is an open question and one that I think needs clinical trials to, to determine the answer. You know, one, one issue there is that [00:18:00] even in people who have sepsis, although they may be at increased risk in the future, um. The absolute risks are still low, you know, so in some of our work, for example, we found that, uh, after sepsis, the risk of having a stroke was about.

5%, right? So one in 200 people would go on to have a stroke within, um, uh, within several months of the septic event. So the risk, you know, in absolute terms is low, even though. They were higher for somebody who had sepsis than for somebody who didn’t. So it, what that means, right, is that in order to have a clinical trial that demonstrates a benefit of a preventive treatment, you need to have a huge sample size to demonstrate it.

So that is a limitation. And, um. You know, I, I think what that also tells us is that we need better ways of predicting which patients with sepsis will go [00:19:00] on to develop, uh, strokes or heart attacks or other events. And, um, you know, that that’s work that’s ongoing. 

Nicole Kupchik: Yeah, and and mean. Like what a heterogeneous population, right?

Which would be really challenging. All right, so we’re gonna go to break and we come back. We’re gonna pick up where we left off and kind of talk about where the research is going and what we can do in the meantime.

Are you a healthcare professional who wants to stay ahead of the curve? Visit sepsis podcast.org to learn more about how you can receive free CME and nursing CE credits. By listening to or watching the sepsis spectrum. It’s our way of supporting you and together better understanding the ever evolving world of sepsis care.

And now back to the show.

[00:20:00] Welcome back from our break. We’re gonna kind of back things up just a bit and talk about the acute phase of sepsis and some of the cardiovascular events that we’re seeing now. Dr. Elkind, I’ve worked at the bedside clinically for over three decades, and it is always surprising to me when I see these.

Septic patients go into AFib and AFib with RVR, and I’m like, why is this happening? Because they really have no cardiac history. Can we talk a little bit about like why we might be seeing AFib in this patient population or even like cardiac dysfunction in general in the acute phase? 

Dr. Mitchell Elkind: Yeah, sure. Well, first of all, as you know.

Cardiovascular events including atrial fibrillation, but, but others as well are quite common in patients with, with sepsis. I think about a third of people will have some cardiovascular event while they’re hospitalized. Uh, and uh, some people have said that atrial fibrillation alone and may [00:21:00] occur in as much as 40% or so of patients with sepsis.

Nicole Kupchik: That is a stat actually, I did not know. 

Dr. Mitchell Elkind: Yeah, that is a crazy stat 

Nicole Kupchik: if you think about it. For up to 40%. 

Dr. Mitchell Elkind: Yeah. And, um, again, not, not even people who necessarily have a cardiac history, as you said. I mean, it, it may be that it’s, you know, sepsis is a kind of stress test, if you will. You know, I think some of the, and, and we’ll come back to this, but some of the, uh, ways that we think about sepsis and cardiovascular disease, uh, I think are similar to the way that we think about pregnancy, frankly, in cardiovascular events.

You know, a lot of people talk about. Pregnancy being a kind of stress test of the body. And, uh, it can bring on hypertension, can bring on, uh, diabetes, and people can have strokes and cardiovascular events in the setting of a shortly after pregnancy. And I, I think, you know, we can think about sepsis almost in, in the same way.

It’s a stress to the body, of course. Um, and sepsis in particular puts great demands on the [00:22:00] heart. Right. So, you know, there’s, there’s changes in volume status. Uh, when people are febrile, the heart is pumping harder and faster, uh, and, uh, there are changes in fluid status and there’s third spacing of fluid.

And there’s, you know, uh, a decrease in volume within the, um. The bloodstream itself. And so all of these fluid changes and cardiac changes and autonomic changes as a result, put greater stress on the the heart. And so that’s probably why we see an increased risk of atrial fibrillation. Why we see an increased risk of, um, heart failure, uh, as well, because with the increased demand.

Especially in people who are already compromised in some way with past history of ischemic disease or uh, something of that sort, then they’re more likely to suffer those consequences. Um, and then on top of it, I think some of these inflammatory effects. Can, can [00:23:00] contribute. And you know, I think of, um, the very high risk of ence encephalopathy that we see in people with sepsis.

You know, as a neurologist, that’s usually why I get called in to see somebody in the, uh, ICU who’s septic is because either they’re having a stroke or they’re having something that makes the team worried about a stroke. And, you know, it may be this, uh, more generalized delirium or encephalopathy and we know that inflammatory.

Molecules, cytokines, and, um, others can contribute to this encephalopathy. We don’t a hundred percent understand how that happens, but you know, just like the kidneys don’t work right in sepsis, the brain doesn’t work right in sepsis. And so it’s really a combination of multiple. You know, effects again, inflammation, um, uh, cardiac demands, and, and you know, some of it could be secondary to medications that are used as well, right?

So as we’re treating people with antibiotics and, [00:24:00] and, uh, um. Autonomic agents and patho medics and so forth, those can have their own impacts on cardiac function that may lead to, uh, heart failure or atrial fibrillation. So teasing out the exact single cause is gonna be challenging. Uh, these are patients who are sick and have a lot going on.

Nicole Kupchik: Yeah. Well, for a while there, we, you know, the, the buzz was, it was myocardial depressant factor. Is that a thing anymore or do we talk about those types of markers? 

Dr. Mitchell Elkind: Yes, I think that there can certainly be a cardiomyopathy that occurs in the setting of, uh, sepsis. Uh, we again certainly saw a lot of that during COVID as well.

Uh, and yeah. And so the, the autonomic effects, uh, can be, can be quite profound in some patients. And, you know, there may be some specificity depending on the agent or organism that’s causing the septic syndrome. Uh, there. Um, is probably an [00:25:00] impact of the severity of the infection as well. Uh, and, uh, and certainly the premorbid state of an individual, what their own cardiac function was and who’s kind of on the, you know, on the threshold.

And it just takes a little bit to push ’em over the edge. 

Nicole Kupchik: You know, and it’s that, that whole sepsis brain connection as well. I mean, you always hear like the, you’re, you know, as we jokingly say in the hospital, we make fun of the emergency department just in, in fun, right? But, uh, you know, you’re getting an 82-year-old who’s got a urinary tract infection who’s pleasantly confused, and then that pro or patient gets labeled dementia when they didn’t have dementia, right?

They’ve got an encephalopathy from their sepsis. 

Dr. Mitchell Elkind: Yeah. Thank you for, for posing it that way too because I think a lot of people don’t, uh, think of encephalopathy versus, you know, long-term con consequences like dementia. And, uh, certainly people can have the acute effect, uh, without necessarily going on to have long-term [00:26:00] problems.

And, uh, it’s important to keep that in mind. How we prognosticate among patients. You know, I can’t tell you how many times somebody will say, oh, well, they’re just demented. Like, you know, don’t worry or don’t bother with them. But, but often we don’t know. And people make assumptions about, uh, somebody’s neural, you know, neurological status based on how they are acutely rather than what they were before or maybe come afterwards.

But that said, um, it’s also important to keep in mind that. Sepsis, just like almost any acute insult can lead to or be a, a trigger for, um, the beginning of, of a, you know, dementia, it’s, it’s quite common, for example, that we’ll see even after. Orthopedic surgery when somebody wakes up, but they’re not quite right.

And it may be the first time that family members appreciate, uh, cognitive impairment. So, you know, [00:27:00] people may have been declining slowly, but nobody really noticed it. Then they have an episode like sepsis and they’re never quite the same after that. Um, and so I, I think again, some of those things that happen acutely.

Persist long term, certainly weeks, maybe months or, or even years after the event. And, um, uh, you know, again, that’s why it’s helpful to use the septic. Episode, you know, or hospitalization as an opportunity to reevaluate both neurologic and cardiovascular function and see whether somebody may need to be on statins or, you know, antithrombotic therapies or blood pressure medications be assessed if necessary for, uh, a neurodegenerative condition that nowadays we do have treatments for, you know, we have drugs for Alzheimer’s disease and so forth, so.

When people survive the acute event, we don’t wanna forget about the fact that they still have, uh, a lifetime ahead of them, [00:28:00] and that we can try to address those problems as well. Again, it’s not unlike the situation with pregnancy where there’s a real movement now to think about, um, the, what, what might happen acutely during pregnancy as an opportunity to then take care of the mother long term after that acute event as well.

Nicole Kupchik: Now, lemme ask you this. So many times when patients do get discharged home, uh, you know, they’re left in the care of a pri their primary care provider, which I’m sure, and I know there’s new codes that they can spend more time, uh, with the patient for reimbursement and things like that. But I mean, truly what advice would you have to a discharging physician or nurse practitioner?

As far as longer term referrals, like what types of specialist would you say, you know, I’d, I’d really think about this, uh, when this, as this complex patient is getting discharged. 

Dr. Mitchell Elkind: [00:29:00] Well, um, I think that the, uh, the. The focus should be on, uh, these kinds of long-term consequences that might arise, and I think that it, a, a good primary care doctor would certainly be, you know, person number one, to continue to follow somebody after an event like this and someone who’s attuned to the possibility of these cardiovascular and neurologic long-term effects.

Now, that’s not to say every patient after sepsis needs to see a cardiologist and a neurologist. But I think, uh, if somebody has had cardiovascular complications, of course, during the, uh, septic hospitalization or has had, uh, certainly neurologic complications, that might be somebody who should then be followed by the appropriate specialists.

Uh, again, because the sepsis and the the things that happen in the hospital may just be the first indication of what could be a longer term problem. [00:30:00] Um. You know, again, thinking about, uh, these kinds of long-term effects after, um, sepsis or, or even milder infections. So honestly, some of our, uh, observational studies and research have shown that it doesn’t even have to be sepsis to put somebody at increased risk of future strokes and heart attacks.

Uh. Even upper respiratory infections that are milder, like, um, you know, viral upper respiratory infections or episodes of pneumonia can lead to later heart failure and stroke risk. Really? Yeah. Huh, 

Nicole Kupchik: that’s, I mean, that’s fascinating. 

Dr. Mitchell Elkind: Yeah, and it’s, it’s probably again, a question of severity. So, uh, certainly sepsis is the, you know, it’s kind of the peak severity of an infectious event and brings with it a lot of the thrombo inflammation and cardiovascular effects.

But milder infections may do the same thing in some cases as well. Uh, [00:31:00] it, it’s a question of how severe the infection is, as well as what the host response is. You know, different people are gonna react. To an infection in different ways. And so, um, you know, certain patients are more likely to develop these complications than others.

You know, we have found, for example, that people with a history of certain kinds of cancer, or certainly people who have a history of, uh, DVT or pulmonary embolism, uh, seem to be at increased risk as well. So, you know, it’s, it’s not only the, the infection, it’s the individual suffering, the infection that drives these kinds of phenomena.

But we know, for example, that, um. Vaccination is important for prevention of not only the infection, like flu vaccination, for example, uh, is recommended for patients who have a history of cardiovascular disease to prevent future cardiovascular events because. If you have heart disease and you have the flu, you’re more likely to have a heart attack.

And one could imagine a similar, uh, approach in [00:32:00] people who’ve had sepsis. So you’ve had sepsis, boy, you know, you should really be careful about not getting flu, not getting, you know, uh. Streptococcal pneumonia, uh, and other things that we can prevent with COVID. Certainly, you know, other things that we can prevent with vaccination to avoid, uh, those secondary cardiovascular complications.

So I think, you know, vaccination is an important part. Primary care doctor where necessary neurologists, cardiologists, where people have those kinds of problems. And, and thinking again about. Traditional vascular prevention if somebody’s at high enough risk, so statins, anti-platelet agents or uh, anti, uh, you know, anti-hypertensives or, uh, medications for metabolic disease like the GLP ones, whatever is appropriate in that individual’s case.

Nicole Kupchik: Well, and there’s so much interesting research that is blossoming about GLP one drugs right now, and I’m, it’s gonna be, I think, exciting to see if there is a [00:33:00] connection in these patients who are in a chronic state of inflammation and possibly going on a GLP one drug for that. So I recently was diagnosed with cancer and luckily I had surgery, took care of it, but, uh, my physician actually recommended my surgeon, oncology surgeon recommended I go on a GLP one just.

To decrease the recurrence risk by decreasing inflammation. 

Dr. Mitchell Elkind: Well, that’s, um, I’m glad to hear you’re doing well. Um, and, uh, that’s interesting about the GLP one. In that setting, I wasn’t aware, but in, in neurology certainly we’re, we’re seeing all kinds of potential uses. Um, we need. A lot more data certainly, but in, um, you know, uh, addictive behaviors including substance abuse and, and even gambling and uh, alcohol abuse and so forth.

Uh, there, there seems to be a benefit. 

Nicole Kupchik: Yeah. Clinical trials.gov, you can see all the studies that are ongoing, so. Alright. Well, I just, I wanna thank you for being here today and if you could give our listeners [00:34:00] one to two takeaway points about our discussion and just things that you’re. Thinking of and you’re seeing in your position with the American Heart Association, what are a couple takeaways that you would send our listeners off with?

Dr. Mitchell Elkind: So I think, um, I think of sepsis as having several different, um. Uh, effects. And one of them is certainly acutely. And, uh, you know, thanks to the sepsis alliance for addressing, uh, those acute complications and I know how much great work is, is being done by the organization and making sure sepsis care, uh, is, you know, as, as, as good as it can be everywhere.

Um. I think that it’s interesting to think about sepsis as another cardiovascular risk factor and stroke risk factor specifically, uh, is how I think about it. And I think we’re just beginning to understand that we’re just beginning to get the data in showing, um, the implications of having a [00:35:00] severe infection, particularly sepsis, uh, on one’s long-term health.

And, uh, that the impact doesn’t go away immediately. Uh, that suffering an event like sepsis carries with it, um, months if not years, of, uh, long-term effects. And so we need to figure out what to do about that. And that’s where I think exciting research is gonna come in the future is how we adjust. The vascular prevention medications, how we handle vaccination in that setting, and how we use anti-inflammatory medications to help reduce the risk associated with sepsis long term as well.

Nicole Kupchik: Well, I just wanna thank you for being here today. Uh, you definitely have. Uh, enlighten me on quite a few things here in our discussion. And I just, I wanna thank you for all the work that you’re doing at, with the American Heart Association. It’s, um, it’s, it’s very impressive to read your CV and just know all the science and moving science forward and all the work that you’ve been [00:36:00] doing in that field.

So just thank you so much for everything you’ve been doing. 

Dr. Mitchell Elkind: Of course, my pleasure. Thank you again for having me in the American Heart Association here today.

Nicole Kupchik: Well, thanks for joining us on this episode. You know, just to reflect on what Dr. Elkind and I talked about, I, I think it just makes you realize how absolutely complex sepsis is and can be, and how challenging it is for. So many primary care providers to manage these patients once they get discharged from the hospital.

But you know, especially drilling down, just knowing that inflammation can really wreak havoc on someone’s body, especially someone who as a baseline is at risk for cardiovascular disease. It’s just, it’s very thought provoking. So anyway. Well, I wanna thank you for joining me on today’s episode of the Sepsis Spectrum.

If you have a story you want me to read on the air, visit [00:37:00] www.humancontent.com/sepsis. And if you’re enjoying the sepsis spectrum, we wanna hear about it. Please leave review wherever you’re enjoying this podcast. It helps. Aton. You can also reach me in our awesome team@infoatsepsis.org or visit sepsis podcast.org to share any stories of your own questions, concerns, or episode ideas.

To learn more about Sepsis Alliance, visit sepsis.org. The sepsis spectrum is brought to you by Sepsis Alliance. I’m your host, Nicole Kupchik. Our executive producers are Allison Strickland, Hannah Sass, Claudia Orth, and Alex Colvin. Our producers are Aron Korney, Rob Goldman, Shahnti Brook, and me Nicole Kupchik.

Our post-production producer is Sundus Hassan Nooli. Our editor and engineer is Jason Portizo, and our music is by Omer Ben-Zvi to learn about. Sepsis Alliance’s podcast, legal disclaimer and compliance policies. You can visit sepsis podcast.org/disclaimers. The sepsis [00:38:00] spectrum is a human content and sepsis alliance production.

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