IT TAKES A TEAM: IMPLEMENTATION OF A MULTIDISCIPLINARY ENDOCARDITIS HEART TEAM AT A CANADIAN TERTIARY CARE REFERRAL CENTRE

Abstract

<h3>BACKGROUND</h3> Management of patients with infective endocarditis (IE) is complex and associated with a high mortality and morbidity. Both European and American Societies of Cardiology recommend implementation of an infective endocarditis team (IET) involving multiple specialities including cardiology, infectious diseases, cardiac surgery, neurology, and addiction medicine. The objective of this study was to evaluate the clinical outcomes before and after implementation of such a team at our institution. <h3>METHODS AND RESULTS</h3> An observational before-and-after study was conducted on 89 consecutive patients with definite IE treated at one tertiary care center between July 2019 and April 2021. The study was divided into two periods: before (n=54) and after (n=39) implementation of the IET on July 1, 2020. The IET consisted of cardiologists with expertise in echocardiography, infectious diseases specialists, cardiac surgeons, and included involvement by a neurologist, radiologist, microbiologist, addiction medicine specialist, and/or intensivist as necessary. The patients' attending physicians were also invited to participate in discussion. Weekly meetings were conducted, and recommendations were provided to the treating team regarding further investigation or medical and/or surgical therapy. The IET was able to meet every week as well as when needed to discuss ad-hoc cases. Importantly, it also enabled the discussion of cases from referring community hospitals. Baseline demographic, echo, and microbiologic characteristics were similar between the before and after groups (Table) except a trend towards a lower proportion of patients with systemic embolization after implementation of the IET (36% vs. 52%, p=0.10). The IET led to involvement of a cardiac surgeon in all cases, compared to only in 76% previously. The proportion who were ultimately considered for surgery overall (54% vs. 76%, p < 0.01) and urgent surgery was lower (51% vs. 71%, p=0.11). However, there was a reduction in time from consultation to urgent surgery that reached borderline significance (3.4 ± 3.3 vs. 8.7 ± 9.8 days, p=0.053). <h3>CONCLUSION</h3> Implementation of a multidisciplinary IET is feasible within a Canadian hospital setting and facilitates routine and timely consultation with cardiovascular and infectious diseases experts. The IET led to a borderline significant reduction in the time from consultation to surgery in patients whom urgent surgery was indicated. These results are preliminary and ongoing study is required to characterize the longer-term outcomes of the IET.