Abstract
BackgroundNationwide hospital admissions data series have contributed to a reliable assessment of the changing epidemiology of infective endocarditis, even though conclusions are not uniform. We sought to use a recent populational series to describe the temporal trends on the incidence of infective endocarditis, its clinical characteristics and outcome results, in Portugal.MethodsA nationwide retrospective temporal trend study on the incidence and clinical characterization of patients hospitalized with infective endocarditis, between 2010 and 2018.Results7574 patients were hospitalized with infective endocarditis from 2010 to 2018 in Portuguese public hospitals. The average length of hospitalization was 29.3 ± 28.7 days, predominantly men (56.9%), and 47.1% had between 60 and 79 years old. The most frequent infectious agents involved were Staphylococcus (16.4%) and Streptococcus (13.6%). During hospitalization, 12.4% of patients underwent heart valve surgery and 20% of the total cohort died. After a 1-year post-discharge follow-up, 13.2% of the total initial cohort had had heart valve surgery and 21.2% in total died. The annual incidence of infective endocarditis was 8.31 per 100,000 habitants, being higher in men (9.96 per 100,000 in males versus 6.82 in females, p < 0.001) and increased with age, peaking at patients 80 years old or older (40.62 per 100,000). In-hospital mortality rate significantly increased during the analyzed period, the strongest independent predictors being ischemic or hemorrhagic stroke, sepsis, and acute renal failure. Younger age and cardiac surgery had a protective effect towards a fatal outcome.ConclusionsIn Portugal, between 2010 and 2018, the incidence of infective endocarditis presented a general growth trend with a deceleration in the most recent years. Also, a significant rate of in-hospital complications, a mildly lower than expected stable surgical rate and a still high and growing mortality rate were noted.
Highlights
Infective endocarditis (IE) is an old and rare disease, with an annual incidence in populational studies of 4 to 10 cases per 100,000 per habitants [1]
The use of modified Duke criteria [13] has been the mainstay for the diagnosis of IE in Portugal, with a gradual integration of the newer imaging modalities since 2015 as per European scientific guidelines indication [7].To avoid overcounting, we identified the first episode of each patient with an IE compatible code for the analyzed period
Medical background and in‐hospital outcomes 7574 patients were admitted with incident IE from 2010 to 2018 in Portugal, with 8172 episodes of hospitalization—see Table 1
Summary
Infective endocarditis (IE) is an old and rare disease, with an annual incidence in populational studies of 4 to 10 cases per 100,000 per habitants [1]. A shift in the epidemiology of endocarditis has been noted in the most recent literature [3,4,5], with older and more complex patients, Staphylococcus aureus as an important and emerging agent, a growing susceptible adult population of patients with congenital heart disease or intracardiac prosthesis or devices and chronic renal failure on dialysis. Several questions remain unanswered regarding epidemiological and outcome results in patients hospitalized with IE in Portugal. Nationwide hospital admissions data series have contributed to a reliable assessment of the changing epidemiology of infective endocarditis, even though conclusions are not uniform. We sought to use a recent populational series to describe the temporal trends on the incidence of infective endocarditis, its clinical characteristics and outcome results, in Portugal
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