Infective Endocarditis in the Elderly: Challenges and Strategies

Abstract

The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term “elderly” corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.

A Fatal Case of Native Valve Endocarditis with Multiple Embolic Phenomena and Invasive Methicillin-Resistant Staphylococcus aureus Bacteremia: A Case Report from the Maldives

“…Presently, the incidence of IE is increasing in different regions, and IE has been reported to affect up to 7 to 10 people per 100,000 person-years [ 11 ]. Several predisposing factors for the development of IE have shifted from conditions such as rheumatic heart disease or congenital heart diseases to degenerative valve disease due to the increasingly aging population [ 12 , 13 ]. In addition, the increased use of prosthesis and intra-cardiac devices are factors that predispose an individual to the development of IE [ 14 ].…”

Clinical Presentation and Risk Factors of Infective Endocarditis in the Elderly: A Systematic Review

“…Infective endocarditis (IE) is an infection of the heart’s inner lining, known as the endocardium [ 1 ] with a high mortality and morbidity rate [ 2 , 3 ]. It is estimated that the number of incident cases has increased by 128% from 1990 to 2019, with an increased age–specific incidence rate for the population over 60 years old, with an overall five-fold increased risk of IE compared with the general population of adults which stands between 3 and 7 cases per 100 thousand patients [ 4 ].…”

“…Considering the continuously rising incidence and moving towards the aging global population [ 4 ], studies need to focus on this specific cohort, considering that older individuals have a higher prevalence of comorbidities and present with nonspecific symptoms that make the diagnosis difficult [ 2 ]. Infective endocarditis is defined by a wide variety of nonspecific symptoms [ 3 , 5 , 6 ], with fever, chills, nausea, dyspnea, anorexia, weight loss, weakness and fatigue, headaches and shortness of breath [ 3 , 7 ].…”

Antibacterial and Antifungal Management in Relation to the Clinical Characteristics of Elderly Patients with Infective Endocarditis: A Retrospective Analysis

“…It has been shown that the risk of endocarditis for older people is almost five times higher than that of the general population. The high frequency of undetected degenerative valve disease and the rising use of invasive procedures and implanted medical devices may be examples of such reasons [ 20 ], which may also affect the prognosis of older people with IE [ 21 ]. Several procedures require antibiotic prophylaxis for patients with cardiac conditions who are at a high risk for infective endocarditis, including maxillo-facial procedures and non-dental invasive procedures of the upper and lower gastrointestinal tract, genitourinary and gynecological procedures, and those of the upper and lower respiratory tract, including ear, nose, and throat (ENT) procedures and bronchoscopy [ 22 , 23 ].…”