Abstract 12143: Differences in Outcomes Among Adults Hospitalized for Infective Endocarditis in the United States: The Impact of Congenital Heart Disease

Abstract

Introduction: Increased life expectancy for patients with adult congenital heart disease (ACHD) has created new and unique challenges, including management of complications such as infective endocarditis (IE). Hypothesis: Significant IE outcome differences exist between ACHD and non-ACHD patients. Methods: Hospital discharges with IE in patients >=18 years from the National Inpatient Sample were identified between 2001 and 2016. Weighting was used to create national annual estimates indexed to the United States (U.S.) population. Patients were categorized into age groups: 18-44 years, 45-64 years, and 65+ years. Demographic, clinical, microbiologic, and outcome data were compared stratifying by ACHD status. Results: ACHD-related IE hospitalizations increased over time, from 1.6% in 2001 to 3.5% in 2016 (p<0.001 for trend) with a 315% increase in annualized number of ACHD IE hospitalizations from 0.41/100,000 adults to 1.29/100,000 adults. ACHD patients were younger (mean age 49 vs. 65 years, p<0.001). In-hospital mortality was lower in ACHD patients than non-ACHD patients (5.9% vs. 9.5%, respectively, p<0.001); mortality did not change significantly over time among ACHD patients, while mortality decreased in non-ACHD patients (p<0.001). Mortality was lower in ACHD patients across all age groups (all p<0.01). ACHD patients were more likely to undergo valve surgery during their IE hospitalization (29.8% vs. 6.4%, p<0.001). The etiology of IE varied between groups (p<0.001), with increased streptococcal disease in ACHD patients (29.4% vs. 14.4%). Conclusions: A significant increase in the overall proportion of ACHD IE hospitalizations in the U.S. was identified between 2001 and 2016. ACHD patients had lower in-hospital mortality than non-ACHD patients and were more likely to undergo valve surgery. Further research is needed to better understand factors underlying the increase in ACHD IE cases as well as why ACHD patients have decreased mortality.