Infective endocarditis: incidence and mortality in the North East Thames Region.

Abstract

SUMMARY A survey of infective endocarditis in the North East Thames Regional Health Authority was carried out over a period of 30 months from 1982 to 1984. The incidence, clinical characteristics, and in-hospital mortality were studied. Important causes of endocarditis were dental treatment, the presence of dental disease, drug abuse, and cytoscopy. The omission or incorrect administration of antibiotic prophylaxis in patients with valve disease was noted, but failure of correctly prescribed antibiotic prophylaxis was not recorded. Adverse prognostic features were increased age, prosthetic valve infection, Gram negative or staphylococcal infections, and aortic valve involvement. In contrast, mortality was lower in patients with mitral valve prolapse, ventricular septal defect, and streptococcus viridans infection. Deaths were usually attributable to irreversible complications present at the time of diagnosis. Vegetations were detected on the echocardiogram in half of those studied and mortality was higher in those with vegetations than without. Operation for native valve infection was associated with a low mortality and it is likely that the overall mortality for infective endocarditis has been improved by surgical intervention.Since 19091 infective endocarditis has been the subject of several important surveys. The most recent was from the Medical Services Study Group of the Royal College of Physicians and was completed in 1982.2 4 Earlier reports often came from referral centres and patients were enrolled for up to 10 years so that sufficiently large study groups could be accumulated by single institutions.5-8 Many patients with infective -endocarditis are now managed in district general hospitals whereas in these earlier studies more complex cases sent to referral centres were over-represented. Published data on incidence, mortality, and clinical features are unlikely to reflect accurately the impact of current preventive, diagnostic, and therapeutic interventions.We set out to document the current features of infective endocarditis within the North East Thames regional population, aiming to obtain accurate incidence and-mortality figures. This approach differed from that of the Medical Services Study Group2 -4 which reported from the whole of

Infective endocarditis in the 1980s: Experience at a heart hospital

“…I 2 in a recent study mitral valve IE was more frequent than aortic valve IE. 4 The frequency of vegetations on echocardiogram is similar to that reported.32 A high suspiscion index of IE in our institution as a result of an ongoing study of IE may bias the results to a high detection rate of vegetations.' Some authors include large mobile vegetations as indication for surgeryI6 or as a potential marker of the risk of poor prognosis, and as such, a marker of need of surgical treatment, 33 Nevertheless, patients with large vegetations may respond well to medical therapy.…”

“…Recent estimations on the mean duration of symptoms are 5 f2.4 weeksIs and 6.2 weeks. 4 The diagnosis of IE may not be apparent even after hospital admission. l9 Previous antibiotic therapy, mainly in streptococcal IE, I a delay related to a less severe or a more tolerated disease, or a "minor" clinical expression might also be responsible for delay between symptoms and therapy.…”

Infective endocarditis, 1984 through 1993: a clinical and microbiological survey

“…In previous reports the frequency varies between 3.4 and 37.5% [3,14,20]. In contradiction to what is described in other studies, we did not find a lower mortality in the patients referred to valve replacement [3,6,15,24].…”

“…Another concern is the frequency of autopsy in Viborg County, which decreased during the period from 22% in 1984 to 11% in 1993, increasing the risk of missed cases [12,13]. Two British studies comparable to ours concerning population and study period found an annual incidence of 22 and 23 episodes per million respectively [14,15]. A study by Delahaye et al found a crude incidence of 22.4 cases per million per year [16].…”

“…In our study we only found the presence of cerebral emboli to be a predictor of increased mortality. Previous reports have identified the following to be factors associated with increased mortality: old age, male sex, heart failure, atrioventricular block, prosthetic valve IE, renal impairment, embolic phenomena and IE with S. aureus [5,14,15,20].…”