Background-Substantial infective endocarditis (IE)-related morbidity and mortality may occur even after successful treatment. However, no previous study has explored long-term hard end points (ie, stroke, myocardial infarction, heart failure, cardiovascular death) in addition to all-cause mortality in IE survivors. Methods and Results-A nationwide population-based cohort study was conducted among IE survivors identified with the use of the Taiwan National Health Insurance Research Database during 2000 to 2009. IE survivors were defined as those who survived after discharge from first hospitalization with a diagnosis of IE. A total of 10 116 IE survivors were identified. IE survivors were matched to control subjects without IE at a 1:1 ratio through the use of propensity scores. The primary outcomes were stroke, myocardial infarction, readmission for heart failure, and sudden cardiac death or ventricular arrhythmia. The secondary outcomes were repeat IE and all-cause mortality. Compared with the matched cohort, IE survivors had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.59; 95% confidence interval [CI], 1.40-1.80), hemorrhagic stroke (aHR, 2.37; 95% CI, 1.90-2.96), myocardial infarction (aHR, 1.44; 95% CI, 1.17-1.79), readmission for heart failure (aHR, 2.24; 95% CI, 2.05-2.43), sudden death or ventricular arrhythmia (aHR, 1.69; 95% CI, 1.44-1.98), and all-cause death (aHR, 2.27; 95% CI, 2.14-2.40). Risk factors for repeat IE were older age, male sex, drug abuse, and valvular replacement after an initial episode of IE. Conclusion-Despite treatment, the risk of long-term major adverse cardiac events was substantially increased in IE survivors. (Circulation. 2014;130:1684-1691.)Key Words: endocarditis ◼ epidemiology ◼ heart failure ◼ mortality ◼ myocardial infarction ◼ stroke © 2014 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.114.012717Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. addition, a recent nationwide population-based study of patients with IE in Sweden found that the increased risk of long-term mortality persists for up to 5 years. 12 Although the long-term mortality of patients with IE has been studied previously, hard end points other than mortality have not been considered by exploring the risk of major adverse cardiac events (MACEs), including stroke, myocardial infarction, heart failure, cardiovascular death, and all-cause death, in these patients.To reduce the effects of potential confounders stemming from inadequate control for comorbidities and underpowered sample sizes, we used Taiwan's National Health Insurance (NHI) Research Database (NHIRD) to conduct a propensity score-matching study. Our goal was to evaluate long-term adverse cardiac outcomes and mortality in a large, representative group of patients with IE compared with a matched cohort using this nationwide database. Methods Data SourceData were extracted from the NHIRD...

BackgroundLong‐term cardiovascular outcomes after sepsis in patients with chronic kidney disease are not well known. We aimed to examine the risk of subsequent cardiovascular events in patients with chronic kidney disease discharged after hospitalization for sepsis in Taiwan.Methods and ResultsUsing complete claims data for patients with chronic kidney disease from Taiwan's National Health Insurance Research Database, we identified patients with sepsis who survived hospitalization between 2000 and 2010. Each sepsis survivor was propensity score–matched to one nonsepsis hospitalized control patient. Cox regression models were used to estimate the hazard ratios (HRs) of clinical outcomes, including major adverse cardiovascular events (myocardial infarction and ischemic stroke), hospitalization for heart failure, and all‐cause death. Among 66 961 sepsis survivors, the incidence rates of all‐cause mortality and major adverse cardiovascular events during the study period were 288.51 and 47.05 per 1000 person‐years, respectively. In comparison with matched hospitalized nonsepsis control patients, sepsis survivors had greater risks of major adverse cardiovascular events (HR, 1.42; 95% CI, 1.37–1.47), myocardial infarction (HR, 1.39; 95% CI, 1.32–1.47), ischemic stroke (HR, 1.46; 95% CI, 1.40–1.52), hospitalization for heart failure (HR, 1.55; 95% CI, 1.51–1.59), and all‐cause mortality (HR, 1.56; 95% CI, 1.54–1.58). The results remained unchanged in analyses of several subgroups of patients, and were similar in analyses accounting for the competing risk of death.ConclusionsOur findings highlight the association of sepsis with a significantly increased long‐term risk of cardiovascular events among survivors in the chronic kidney disease population.