Inception of the ‘endocarditis team’ is associated with improved survival in patients with infective endocarditis who are managed medically: findings from a before-and-after study

Abstract

ObjectiveDespite improvements in its management, infective endocarditis (IE) is associated with poor survival. The aim of this study was to evaluate the impact of a multidisciplinary endocarditis team (ET), including a cardiologist, microbiologist and a cardiac surgeon, on the outcome of patients with acute IE according to medical or surgical treatment strategies.MethodsWe conducted an observational before-and-after study of 196 consecutive patients with definite IE, who were treated at a tertiary reference centre between 2009 and 2015. The study was divided into two periods: period 1, before the formation of the ET (n=101), and period 2, after the formation of the ET (n=95). The role of the ET included regular multidisciplinary team meetings to confirm diagnosis, inform the type and duration of antibiotic therapy and recommend early surgery, when indicated, according to European guidelines.ResultsThe patient demographics and predisposing conditions for IE were comparable between the two study periods. In the time period following the introduction of the ET, there was a reduction in both the time to commencement of IE-specific antibiotic therapy (4.0±4.0 days vs 2.5±3.2 days; P=0.004) and the time from suspected IE to surgery (7.8±7.3 days vs 5.3±4.2 days; P=0.004). A 12-month Kaplan-Meier survival for patients managed medically was 42.9% in the pre-ET period and 66.7% in the post-ET period (P=0.03). The involvement of the ET was a significant independent predictor of 1-year survival in patients managed medically (HR 0.24, 95% CI 0.07 to 0.87; P=0.03).ConclusionsA standardised multidisciplinary team approach may lead to earlier diagnosis of IE, more appropriate individualised management strategies, expedited surgery, where indicated, and improved survival in those patients chosen for medical management, supporting the recent change in guidelines to recommend the use of a multidisciplinary team in the care of patients with IE.

Infective endocarditis in the Netherlands: current epidemiological profile and mortality

“…An Endocarditis Team has been reported to reduce mortality in IE patients, although these results stem from historical control data [21,22]. In the most recent update of the guidelines for the management of patients with endocarditis, the constitution of an Endocarditis team is recommended as a crucial part in the improvement of care for patients with IE.…”

The value of an “Endocarditis Team”

“…They reported that the adoption of a multidisciplinary treatment strategy during the last years of the study led to an increase in the early elective surgery rates from 22% to 32% (P<0.05), which resulted in a significant reduction in the overall in-hospital mortality from 25% to 12% (P<0.01) (22). The adoption of the Endocarditis Team concept has also been found to be a significant independent predictor of 1-year survival in IE patients (HR 0.24, 95% CI: 0.07 to 0.87; P=0.03) (23). The current guidelines for the management of IE, thereby, strongly recommend the utilization of a specialized team (Endocarditis Team) in the treatment of patients with IE in reference centers (12,24,25).…”

Early prosthetic valve endocarditis after transcatheter aortic valve implantation using St Jude Medical Portico valve

“…The study showed a 66.7% survival at 1 year in the group treated under the ET supervision compared with 42.9% without ET supervision (p=0.03). Moreover, early involvement of ET showed significant reduction in the time to starting treatment for IE and the time to surgical intervention when indicated (p=0.004) 28. Therefore, early involvement of the ET is recommended in patients with suspected PVE after TAVI to help reduce mortality and facilitate early diagnosis and treatment.…”