Effects of changes in management of active infective endocarditis on outcome in a 25-year period

Abstract

The clinical outcome and long-term follow-up of 130 consecutive patients (141 episodes) with active infective endocarditis who were treated between 1966 and 1991 were analyzed. There was a shift toward a higher proportion of referred patients (39 to 78%), patients aged >60 years (11 to 41%) and urgent surgical treatment (11 to 44%). Medical treatment was administered in 98 patients (70%); 30-day mortality was 27%. Surgery was performed in 43 patients (30%), with an operative mortality of 26%; 9 of 14 patients (64%) who underwent operation within the first week of admission died. Patients with severe heart failure are at the highest risk for early mortality (relative risk = 21.1; 95% confidence interval 7.4–60.3). Referred patients were much more often treated surgically than were nonreferred patients (48 versus 14%) and had a lower operative mortality (24 vs 30%). Nonreferred patients were more often treated medically (86 vs 52%) and with lower mortality (19 vs 39%). The total follow-up time was 730 patient-years; only 1 patient was considered lost to follow-up. The overall cumulative 5-year and 10-year survival after hospital discharge for patients after urgent surgery were 84 ± 7% and 53 ± 7%, respectively, and for those after medical treatment 84 ± 5% and 77 ± 6%, respectively. The probability of remaining free of late events (recurrent endocarditis, late valve replacement or death) during 5 and 10 years for patients after urgent surgery was 84 ± 7% and 53 ± 15%, respectively, and for those after medical treatment 59 ± 6% and 40 ± 7%, respectively. In the first year after hospital discharge, the incidence of late events was high, especially in patients who received only medical treatment. Although urgent surgery has improved the outlook for some patient groups, early mortality did not decrease significantly owing to a shift toward more compromised cases.