Importance of In-Hospital Prospective Registry and Infectious Endocarditis Heart Team to Monitor and Improve Quality of Care in Patients with Infectious Endocarditis

Abstract

Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE. Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced. Propensity score matching was used to assess the impact of an IEHT approach on clinical outcomes. Results: Median age was 72.5 y (62.75–80.00), diabetes was present in 33.1%, chronic kidney disease in 27.5%, COPD in 17.5%, and a history of ischaemic heart disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients. Staphylococcus (37.5%) was the most frequent pathogen followed by streptococcus (24.4%) and enterococcus (23.1%). Overall, 30-day and 1-year mortality were 19.4% and 37.5%, respectively. The introduction of prospective data collection and IE heart team was associated with a trend towards reduction of adjusted 1-year mortality (26.5% IEHT vs. 41.2% controls, p = 0.0699). An IEHT clinical decision-making approach was independently associated with a shorter length of stay (p = 0.04). Conclusions: Use of a prospective registry of IE coupled with a heart team approach was associated with more efficient patient management and a trend towards lower mortality. Prospective data collection and dedicated IEHT have the potential to improve patient care and clinical outcomes.

Multidisciplinary Teams for the Management of Infective Endocarditis: A Systematic Review and Meta-analysis

“…Each observed that MDT management was still associated with reduced mortality after adjusting for the calendar year. Two studies [ 22 , 32 ] also performed an analysis with propensity score matching between cohorts; both revealed a reduction in mortality with MDT management.…”

Infective endocarditis treated in a secondary hospital: epidemiological, clinical, microbiological characteristics and prognosis, with special reference to patients transferred to a third level hospital

“…Other authors have analysed cohorts of patients treated in hospitals without heart surgery facilities, highlighting cohorts with a lower mortality rate than that which is usually published (19%). They also found that the creation of a multidisciplinary working group and the implementation of protocols reduces this figure even further (8-14%) [11,[25][26][27][28][29]. A more recent cohort suggests that patients treated in secondary centres may be older and have more comorbidities [30].…”

“…In view of this, it is essential to implement agreed protocols adapted to the characteristics of each hospital and to draw up user-friendly guidelines, benefitting from the services of at least one clinical consultant specialising in infectious diseases in secondary hospitals. The active participation of the infectious disease consultant has been associated with better outcomes in patients with bacteraemia and endocarditis, specified in various guidelines as being an alternative-almost mandatory-in the diagnostic and therapeutic assessment and during the monitoring of these patients [11,[25][26][27][28][29]32]. Unsuitable antibiotic therapy is a particularly relevant factor, as it can be modified.…”

Is Infectious Endocarditis Evolving into a Time-Dependent Diagnosis in the Contemporary Epidemiological Era? Emphasis on the Role of Echocardiography as a First-Line Diagnostic Approach

“…The diagnosis is based almost exclusively on imaging and primarily on echocardiography. Conversely, the endocarditis team approach has improved patient outcomes [ 69 , 70 ]. Notwithstanding, two recent European surveys showed that the presence of an endocarditis team is still not dominant and comprises a specialist in echocardiography only in 2/3 of the cases [ 22 , 71 ].…”