Clinical Investigation
Valvular and Congenital Heart Disease
Excess mortality and morbidity in patients surviving infective endocarditis

https://doi.org/10.1016/j.ahj.2012.04.003Get rights and content

Background

Mortality and morbidity associated with infective endocarditis may extend beyond successful treatment. The primary objective was to analyze rates, temporal changes, and predictors of excess mortality in patients surviving the acute phase of endocarditis. The secondary objective was to determine the rate of recurrence and the need for late cardiac surgery.

Methods

An observational cohort study was conducted at a university-affiliated tertiary medical center, among 328 patients who survived the active phase of endocarditis. We used age-, sex-, and calendar year–specific mortality hazard rates of the Bouches-du-Rhone French district population to calculate expected survival and excess mortality. The risk of recurrence and late valve surgery was also assessed.

Result

Compared with expected survival, patients surviving a first episode of endocarditis had significantly worse outcomes (P = .001). The relative survival rates at 1, 3, and 5 years were 92% (95% CI, 88%-95%), 86% (95% CI, 77%-92%), and 82% (95% CI, 59%-91%), respectively. This excess mortality was observed during the entire follow-up period but was the highest during the first year after hospital discharge. Most of the recurrences and late cardiac surgeries also occurred during this period. Women exhibited a higher risk of age-adjusted excess mortality (adjusted excess hazard ratio, 2.0; 95% CI, 1.05-3.82; P = .03). Comorbidity index, recurrence of endocarditis, and history of an aortic valve endocarditis in women were independent predictors of excess mortality.

Conclusions

These results justify close monitoring of patients after successful treatment of endocarditis, at least during the first year. Special attention should be paid to women with aortic valve damage.

Section snippets

Study population

This study took place in the Cardiology Department of La Timone Hospital, Marseille, France, a University-affiliated medical center for adults. In this center, a specific database was created in 1992 to prospectively collect information on the patients with a suspected diagnosis of IE.

From January 2002 to December 2008, all consecutive patients admitted with a first definite diagnosis of IE according to the modified Duke criteria21 were eligible for participation in the study. Among these, only

Patients

The study flow chart is presented in Figure 1. The study population ultimately included 328 patients. Their baseline characteristics are summarized in Table I. The 328 patients were followed up for 731 person-years (median, 2.2 years; range, 6 days to 7 years).

Survival

Fifty-five patients (16.8%) died during the follow up. Among them, 21 were women and 34 were men. The cause of death was unknown in 11 patients; known causes of death included cancer (n = 11), heart failure (n = 11), new sepsis (n = 10 [8

Discussion

Using a relative survival approach, we demonstrated IE excess mortality and morbidity, especially during the first year after hospital discharge. We identified comorbidity, recurrence, and aortic IE localization in women as predictors of this excess mortality.

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