The Impact of Establishing a Regional Infective Endocarditis (IE) Network on Decreasing Diagnostic Latency and Perioperative IE-Related Complications

Objectives: Infective endocarditis is a multidisciplinary challenge that requires high degrees of suspicion and alertness in diagnosis and advanced levels of competence in its surgical treatment. Recent reports document increased complexity of the disease with more S. aureus IE and increased comorbidities. Some population-based studies reported an increase in mortality. In 2015, the European guidelines recommended for the first time the formation of an endocarditis team for optimal treatment. We established a regional IE network with the surrounding hospitals and physicians in addition to the formation of an endocarditis team in 2014. The aim of this study is to evaluate the success of this strategy in reducing the latency in diagnosis and in reducing the incidence of complex IE presentation.

Methods: We analyzed retrospectively data from patients operated for IE in our center from 2007 to 2018. We compared data from patients operated before establishing the IE-network December in 12/2014 to those operated thereafter. The main endpoints were the time needed from the first symptom to cardiac surgery, the presence of cardiac abscess and the occurrence of pre-operative stroke.

Result: Among 630 patients who underwent surgery for IE in our center, 409 (65%) were operated in the first era before 12/2014. Patients who underwent surgery in the 2nd era after 12/2014 were older (64.7 ±12.9 vs. 62.5 ± 13.8, p = 0.056), had more S. aureus IE (36 vs. 25%, p = 0.015), and had more prosthetic valve IE (29 vs. 24%, p = 0.178). However, these patients presented with less IE-related complications, including (less preoperative stroke, (17 vs. 27%, p = 0.029) and lower incidence of cardiac abscess (24 vs. 36%, p = 0.018). The median time from the first IE symptom to surgery was shorter in patients operated during the 2nd era compared with those operated during the 1st era (9 days, IQR: 3–21 vs. 17 days, IQR: 9–36, p < 0.001). The incidence of postoperative stroke (19% for each group) and 30-day mortality (22 vs. 21%, p = 0.76) were similar in both eras.

Conclusion: The creation of an IE network was associated with earlier and faster referral of less advanced IE. Surgical results remained stable despite higher incidence of S. aureus IE and older age. It may be speculated that greater awareness for the disease in the network is the cause for these improvements

Publication History

Article published online:
19 February 2021