Is the clinical spectrum and prognosis of native valve infective endocarditis in non-addicts changing?

Abstract

One hundred and ninety-four episodes of endocarditis on native valves in non-addict patients were diagnosed from 1975 to 1992 and were divided into groups A (78 patients, 1975-1983) and B (116 patients 1984-1992). Both groups had the same gender distribution, similar valvular involvement and microbiological characteristics. In group B patients, median age was older (46 vs 54 years, P = 0.0002), the number of patients without previous heart disease was higher (46% vs 22%, P = 0.02) and the median time of symptoms before diagnosis was shorter (30 vs 50 days, P = 0.038). Both groups had similar incidence of heart failure (32% vs 36%), surgical treatment (30% vs 33%) and embolic episodes (26% vs 34%). Surgical mortality decreased from 43% to 18% (P = 0.03). Overall mortality decreased non-significantly from 19% in group A to 12% in group B. Predictors of death in group A were heart failure (odds ratio 9.6, 95% confidence interval 3-36) and surgical treatment (odds ratio 5, 95% confidence interval 1.3-19). Predictors of death in group B were age (odds ratio 4.98, 95% confidence interval 1.4-19), female sex (odds ratio 5.3, 95% confidence interval 1.3-20), staphylococcal infection (odds ratio 4.9, 95% confidence interval 1.1-22) and heart failure (odds ratio 5.2, 95% confidence interval 1.3-20). Although in recent years infective endocarditis occurs in older patients and is more common in patients with previously unknown heart disease a substantial change in major clinical and prognostic variables is not apparent in our population. Overall in-hospital mortality has decreased from 19% to 12% mainly due to better surgical results.

Clinicomicrobiological profile of infective endocarditis in a tertiary care center of Nepal

“…Increasing age of patients of IE in west is attributable to; markedly decrease frequency of RHD, 12 longer survival of patients with valve disease and CHD because of readily available modern medical and surgical therapy, increased incidence of degenerative valvular disease, 2 aging of the population in general 9,13 and more frequent use of invasive central vascular catheters which are associated with an increase in nosocomiallyacquired endocarditis. There was a significant rise in the age of the patients during the 1940s ,1950s and 1960s 14 and studies covering the time periods 1968-1973, 15 1973-1984 16 and 1970-1977 17 found the mean age to lie within the sixth decade. Our findings suggest that there has been no further increase in the age of the patients and concur with two recent studies.…”

Changing Epidemiology of Infective Endocarditis: A Retrospective Survey of 108 Cases, 1990-1999

“…The prevalence of patients without clear underlying diseases predisposing to IE has risen from around 5% in a Taken prior to the initiation of antibiotic therapy (not available for 8 cases) b No preantbiotic blood culture data was available for eight cases c Calculated by dividing the number of positive blood culture sets by the total number of sets taken in each group d Denotes the frequency of detecting at least one positive blood culture from those taken von Reyn's landmark study [9], using strict case definitions, to around 35-45% [7,10,16,18]. This category seems to include many elderly patients who are at risk for degenerative valvular disease.…”

Endocarditis at a tertiary hospital: Reduced acute mortality but poor long term prognosis

“…The in-hospital mortality from endocarditis has over recent decades commonly been reported to be 20 Á25% [1], although some investigations suggest a decrease in mortality [2]. Thus, a recent Danish investigation from a secondary centre found a mortality of 14% [3].…”