Long-Term Clinical Outcome of Major Adverse Cardiac Events in Survivors of Infective Endocarditis

Abstract

Background-Substantial infective endocarditis (IE)-related morbidity and mortality may occur even after successful treatment. However, no previous study has explored long-term hard end points (ie, stroke, myocardial infarction, heart failure, cardiovascular death) in addition to all-cause mortality in IE survivors. Methods and Results-A nationwide population-based cohort study was conducted among IE survivors identified with the use of the Taiwan National Health Insurance Research Database during 2000 to 2009. IE survivors were defined as those who survived after discharge from first hospitalization with a diagnosis of IE. A total of 10 116 IE survivors were identified. IE survivors were matched to control subjects without IE at a 1:1 ratio through the use of propensity scores. The primary outcomes were stroke, myocardial infarction, readmission for heart failure, and sudden cardiac death or ventricular arrhythmia. The secondary outcomes were repeat IE and all-cause mortality. Compared with the matched cohort, IE survivors had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.59; 95% confidence interval [CI], 1.40-1.80), hemorrhagic stroke (aHR, 2.37; 95% CI, 1.90-2.96), myocardial infarction (aHR, 1.44; 95% CI, 1.17-1.79), readmission for heart failure (aHR, 2.24; 95% CI, 2.05-2.43), sudden death or ventricular arrhythmia (aHR, 1.69; 95% CI, 1.44-1.98), and all-cause death (aHR, 2.27; 95% CI, 2.14-2.40). Risk factors for repeat IE were older age, male sex, drug abuse, and valvular replacement after an initial episode of IE. Conclusion-Despite treatment, the risk of long-term major adverse cardiac events was substantially increased in IE survivors. (Circulation. 2014;130:1684-1691.)Key Words: endocarditis ◼ epidemiology ◼ heart failure ◼ mortality ◼ myocardial infarction ◼ stroke © 2014 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.114.012717Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. addition, a recent nationwide population-based study of patients with IE in Sweden found that the increased risk of long-term mortality persists for up to 5 years. 12 Although the long-term mortality of patients with IE has been studied previously, hard end points other than mortality have not been considered by exploring the risk of major adverse cardiac events (MACEs), including stroke, myocardial infarction, heart failure, cardiovascular death, and all-cause death, in these patients.To reduce the effects of potential confounders stemming from inadequate control for comorbidities and underpowered sample sizes, we used Taiwan's National Health Insurance (NHI) Research Database (NHIRD) to conduct a propensity score-matching study. Our goal was to evaluate long-term adverse cardiac outcomes and mortality in a large, representative group of patients with IE compared with a matched cohort using this nationwide database. Methods Data SourceData were extracted from the NHIRD...

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

“…In the ICE‐PCS cohort, in‐hospital mortality was associated with IE complications of prosthetic or mitral valve IE, pulmonary edema, paravalvular complication, and S aureus infection 1. Longer term studies have demonstrated higher mortality rates in IE patients beyond the index hospitalization, predominantly due to noncardiovascular conditions 4, 5. A recent study from Taiwan using administrative claims also found higher risk of cardiovascular events in long‐term follow‐up 5.…”

“…Longer term studies have demonstrated higher mortality rates in IE patients beyond the index hospitalization, predominantly due to noncardiovascular conditions 4, 5. A recent study from Taiwan using administrative claims also found higher risk of cardiovascular events in long‐term follow‐up 5. In our previous study of 1‐year survival after prosthetic valve endocarditis, the rate of mortality remained high for the first 4 months after admission for IE in patients treated with medical therapy alone or in combination with surgery 16…”

“…Despite improvements in diagnostic testing, antimicrobial treatment, and surgical intervention, changes in the epidemiology of IE, including the rise of health care–associated infection and Staphylococcus aureus as a virulent causative organism,2, 3 increase the risk of complications and death in the acute phase of IE. Furthermore, survival after hospital discharge may be reduced by late complications and comorbid conditions 4, 5…”

Comparative effectiveness of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers in patients with type 2 diabetes and retinopathy

“…This database contains detailed medical claims data from almost all of Taiwan's inhabitants (average 23 million) since 1995 and has been described in detail previously. 17,18 We used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify important comorbid conditions. We first selected patients with 1 primary discharge diagnosis or 2 outpatient diagnoses of diabetes (ICD-9-CM code 250.x).…”

Incidence and associated risk factors of cancer in patients after infective endocarditis hospitalization: A propensity score matched analysis

“…The relationship between IE and cancer had been reported, however, IE survivors with concomitant use of cardiovascular medication may impact on the results (11). In addition, IE is a complicated and serious infection disease and has a high mortality rate in both in-hospital and long-term follow-up (12,13). This makes the categorical relationship between IE and cancer more difficult to clarify.…”