The clinical features and prognosis of infective endocarditis in the elderly from 2007 to 2016 in a tertiary hospital in China

Abstract

BackgroundInfective endocarditis (IE) especially in the elderly is a serious disease, with a worse prognosis.MethodsA retrospective cohort study was conducted. A total of 405 patients with definite IE were divided into three groups: 205 patients under 50 years old, 141 patients between 50 and 64 years old and 59 patients over 65 years old.ResultsFor older patients, clinical symptoms such as fever, anemia, and heart murmur were as common as the younger patients. IE in old patients had more frequent nosocomial origin (P = 0.007) and tended to be more frequent with bad oral hygiene (p = 0.008). The most frequent isolated pathogens in the old groups was streptococci and coagulase-negative staphylococci. The old patients had a lower operation rate (40.7% vs 58.9% vs 62.4%, P = 0.012) and higher in-hospital mortality (20.3% vs 10.6% vs 8.8%, P = 0.044) compared with the younger patients. Surgical treatment was a significant predictor of one-year mortality even after adjusting for the confounders (HR = 2.45, 95% CI 1.027–10.598, P = 0.009). The one-year survival rate was higher for older patients with surgical intervention than those without (95.8% vs 68.6%, P = 0.007).ConclusionsOlder patients with IE presented with more comorbidities, bad oral hygiene, more nosocomial origin and a more severe prognosis than younger patients. Streptococci was the most frequent micro-organisms in this group. Surgery were underused in old patients and those with surgical treatment had better prognosis.

Surgical treatment for infective endocarditis in the ageing society: a nationwide retrospective study in Japan

“…Contrasting study findings may also reflect inconsistent definitions of 'elderly', which can range from over 65 years to over 70 years. [10][11][12][13][14][15][16][17] To the best of our knowledge, the present study is one of the largest to focus on IE among very elderly patients. The large sample enabled us to comprehensively investigate the characteristics of IE among very elderly patients in a clinical setting.…”

“…12 Several studies have reported the similarities and the differences of IE among elderly compared with non-elderly patients, some of which showed the conflicting result regarding clinical characteristics such as causative microorganisms and echocardiographic findings. [10][11][12][13][14][15][16][17] This contradiction may be explained by the diversity in health conditions across elderly people. Ageing is a highly variable process characterised by a wide spectrum of conditions: some aged individuals are healthy whereas others are bedridden.…”

“…12 28 The validity of surgical treatment among elderly patients has been investigated by several retrospective analyses focusing on patients over 65 or 70 years. [10][11][12][13][14][15][16][17] Lin et al investigated the mid-term outcome of left-sided native valve IE in 179 patients and concluded that mid-term outcomes are promising once elderly patients over 65 years are stabilised by surgical treatment. 14 However, there are scarce clinical data on the efficacy of surgical treatment for IE among the very elderly population.…”

“…[10][11][12][13][14][15][16][17] In those studies, elderly patients were defined as those over 65 or 70 years, owing to the rarity of IE and the difficulty of collecting sufficient target samples. [10][11][12][13][14][15][16][17] In the real-world clinical setting, the number of healthier elderly people is increasing. Such individuals may be suited to similar treatment strategies as non-elderly people; in contrast, clinicians struggle to manage very elderly patients with IE.…”

Endocardite Infecciosa em Idosos: Características Distintas

“…[4][5][6][7][8][9] Em pacientes da terceira idade com EI, existem diferenças quanto a apresentação clínica, complicações, presença de comorbidades, abordagem terapêutica e mortalidade. 4,[10][11][12][13] Diretrizes de EI não abordam especificamente idosos e não está claro até que ponto elas podem ser utilizadas de maneira adequada nesses pacientes. 2,14,15 A população idosa claramente beneficiou-se do progresso médico, com técnicas diagnóstico-terapêuticas que influenciam no aumento da expectativa de vida e em procedimentos menos invasivos.…”