ObjectivesInfective endocarditis (IE) is a life-threatening disease associated with significant mortality. We studied recent temporal trends and age and sex differences in the occurrence and short-term mortality of IE.DesignPopulation based retrospective cohort study.SettingData of IE hospital admissions in patients aged ≥18 years in Finland during 2005–2014 and 30-day all-cause mortality data were retrospectively collected from mandatory nationwide registries from 38 hospitals.OutcomesTrends and age and sex differences in occurrence. Thirty-day mortality.ResultsThere were 2611 cases of IE during the study period (68.2% men, mean age 60 years). Female patients were significantly older than males (62.0 vs 59.0 years, p=0.0004). Total standardised annual incidence rate of IE admission was 6.33/100 000 person-years. Men had significantly higher risk of IE compared with women (9.5 vs 3.7/100 000; incidence rate ratios [IRR] 2.49; p<0.0001) and difference was most prominent at age 40–59 years (IRR 4.49; p<0.0001). Incidence rate varied from 5.7/100 000 in 2005 to 7.1/100 000 in 2012 with estimated average 2.1% increase per year (p=0.036) and similar trends in both sexes. Significant increasing trend was observed in patients aged 18–29 years and 30–39 years (estimated annual increase 7.6% and 7.2%, p=0.002) and borderline in patients aged 40–49 years (annual increase 3.8%, p=0.08). In older population, IE incidence rate remained stable. The overall 30-day mortality after IE admission was 11.3%. Mortality was similar between sexes, increased with ageing, and remained similar during the study period.ConclusionsOccurrence of IE is increasing in young adults in Finland. Men, especially middle-aged, are at higher risk for IE compared with women. Thirty-day mortality has remained stable at 11%, increased with ageing, and was similar between sexes.

OBJECTIVES The optimal choice of valve prosthesis in surgical aortic valve replacement for infective endocarditis (IE) is controversial. We studied outcomes after mechanical versus biological prosthetic valve surgical aortic valve replacement in IE patients. METHODS All patients with native-valve IE aged 16–70 years undergoing mechanical or biological surgical aortic valve replacement in Finland, between 2004 and 2014, were retrospectively studied (n = 213). Outcomes were all-cause mortality, ischaemic stroke, major bleeding and aortic valve reoperation at 1 year and 5 years. Results were adjusted for baseline features (age, sex, comorbidity burden, atrial fibrillation, valvular stenosis, concomitant coronary artery bypass grafting, extension, urgency, year and centre of operation). Median follow-up was 5 years. RESULTS The 5-year mortality rate was 19.0% with mechanical prostheses and 34.8% with biological prostheses [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.23–0.92; P = 0.03]. Ischaemic stroke rates were 8.3% with mechanical prostheses and 16.8% with biological prostheses at 5 years (HR 0.21, CI 0.06–0.79; P = 0.01). Results were comparable in patients aged 16–59 and 60–70 years (interaction P = 0.84). Major bleeding within 5 years was similar between mechanical (11.3%) and biological valve (13.4%) groups (P = 0.95) with comparable rates of both gastrointestinal and intracranial bleeds. Reoperation rates at 5 years were 5.0% for mechanical prostheses and 9.2% for biological prostheses (P = 0.14). The 1-year ischaemic stroke rate was lower with mechanical prostheses (3.6% vs 11.6%, P =0.03), whereas mortality, major bleeding and reoperation rates were similar between groups. CONCLUSIONS The use of mechanical aortic valve is associated with lower mid-term mortality compared to biological prosthesis in patients with native-valve IE aged ≤70 years. Our results do not support the routine choice of a biological aortic valve prosthesis in this patient group.

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