Abstract
Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE. Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced. Propensity score matching was used to assess the impact of an IEHT approach on clinical outcomes. Results: Median age was 72.5 y (62.75–80.00), diabetes was present in 33.1%, chronic kidney disease in 27.5%, COPD in 17.5%, and a history of ischaemic heart disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients. Staphylococcus (37.5%) was the most frequent pathogen followed by streptococcus (24.4%) and enterococcus (23.1%). Overall, 30-day and 1-year mortality were 19.4% and 37.5%, respectively. The introduction of prospective data collection and IE heart team was associated with a trend towards reduction of adjusted 1-year mortality (26.5% IEHT vs. 41.2% controls, p = 0.0699). An IEHT clinical decision-making approach was independently associated with a shorter length of stay (p = 0.04). Conclusions: Use of a prospective registry of IE coupled with a heart team approach was associated with more efficient patient management and a trend towards lower mortality. Prospective data collection and dedicated IEHT have the potential to improve patient care and clinical outcomes.
Highlights
Infective endocarditis (IE) is a severe disease and is still associated with high morbidity and mortality [1,2,3,4,5]
The objectives of the present study are: (1) to assess the impact of an intervention in the clinical care pathway (i.e., infectious endocarditis heart team approach (IEHT) coupled with prospective data collection) on clinical outcomes; (2) to define patient’s characteristics and outcomes and place these results in perspective with the most recently published prospective registry data of the ESC-EORP
PVE and and Cardiac device-related IE (CDRIE), CDRIE, is sensitivity compared to other centres by echo and PET, is as frequently operated, has sensitivity compared to other centres by echo and PET, is as frequently operated, has a 30a
Summary
Infective endocarditis (IE) is a severe disease and is still associated with high morbidity and mortality [1,2,3,4,5]. Mortality rates vary considerably between different studies. In one of the latest largest registries, the Euro-Endo Registry, including possible and definite IE, in-hospital mortality was 17.1% [1]. Landmark guidelines in the field of IE report intrahospital mortality rates between 15–30% [2,3]. In-hospital mortality is highly influenced by the local integrated care pathway. Strategies aiming at improving care in patients with acute IE have the potential to impact mortality rates.
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