Background-Substantial infective endocarditis (IE)-related morbidity and mortality may occur even after successful treatment. However, no previous study has explored long-term hard end points (ie, stroke, myocardial infarction, heart failure, cardiovascular death) in addition to all-cause mortality in IE survivors. Methods and Results-A nationwide population-based cohort study was conducted among IE survivors identified with the use of the Taiwan National Health Insurance Research Database during 2000 to 2009. IE survivors were defined as those who survived after discharge from first hospitalization with a diagnosis of IE. A total of 10 116 IE survivors were identified. IE survivors were matched to control subjects without IE at a 1:1 ratio through the use of propensity scores. The primary outcomes were stroke, myocardial infarction, readmission for heart failure, and sudden cardiac death or ventricular arrhythmia. The secondary outcomes were repeat IE and all-cause mortality. Compared with the matched cohort, IE survivors had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.59; 95% confidence interval [CI], 1.40-1.80), hemorrhagic stroke (aHR, 2.37; 95% CI, 1.90-2.96), myocardial infarction (aHR, 1.44; 95% CI, 1.17-1.79), readmission for heart failure (aHR, 2.24; 95% CI, 2.05-2.43), sudden death or ventricular arrhythmia (aHR, 1.69; 95% CI, 1.44-1.98), and all-cause death (aHR, 2.27; 95% CI, 2.14-2.40). Risk factors for repeat IE were older age, male sex, drug abuse, and valvular replacement after an initial episode of IE. Conclusion-Despite treatment, the risk of long-term major adverse cardiac events was substantially increased in IE survivors. (Circulation. 2014;130:1684-1691.)Key Words: endocarditis ◼ epidemiology ◼ heart failure ◼ mortality ◼ myocardial infarction ◼ stroke © 2014 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.114.012717Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. addition, a recent nationwide population-based study of patients with IE in Sweden found that the increased risk of long-term mortality persists for up to 5 years. 12 Although the long-term mortality of patients with IE has been studied previously, hard end points other than mortality have not been considered by exploring the risk of major adverse cardiac events (MACEs), including stroke, myocardial infarction, heart failure, cardiovascular death, and all-cause death, in these patients.To reduce the effects of potential confounders stemming from inadequate control for comorbidities and underpowered sample sizes, we used Taiwan's National Health Insurance (NHI) Research Database (NHIRD) to conduct a propensity score-matching study. Our goal was to evaluate long-term adverse cardiac outcomes and mortality in a large, representative group of patients with IE compared with a matched cohort using this nationwide database.
Methods
Data SourceData were extracted from the NHIRD...
