Infective Endocarditis: A Continuous Challenge. The Recent Experience of a European Tertiary Center

Background and aim of the study: The study aim was to monitor infective endocarditis (IE) before and after the condition was brought into focus in hospitals in the Aarhus region of Denmark. Methods: A total of 172 patients with IE, all of whom had been referred to the regional tertiary center during 2000-2001 or during 2005-2006, was included prospectively into the study. Results: Between 2000-1 (n = 51) and 2005-6 (n = 121), a very large (137%) increase occurred in the number of IE patients referred (p <0.01). Yet, over this period, the delay from onset of symptoms to admission remained at one month, with a further prolongation of one week (p <0.05) in 40% of patients who had received pre-hospital antibiotic treatment. A previous healthcare procedure was recorded in 37% of cases, with an ascending trend from 2000-1 to 2005-6. The increase in six-month mortality was high, from 16% to 26%, but was not statistically significant. Independent predictors were prosthetic valve IE (p = 0.02), advanced age (p = 0.03) and co-morbidity (p = 0.05); all three of these features increased over the five-year study interval. Conclusion: Although increased regional hospital attention to IE seemed to facilitate admission to the authors' center, this did not improve survival, apparently because of an unchanged admission delay and increasing age, comorbidity, and prosthetic valve IE. Delayed admission and health care-induced IE were susceptible to modification. Future measures should, therefore, be particularly focused on high-risk patients, on educating the general practitioners, and on improving access to primary healthcare facilities for blood culture and echocardiography.