Demographic and Clinical Correlates of Infective Endocarditis in Non-Rheumatic Aortic Valve Disease: Descriptive Insights From Nationwide Inpatient Study

Abstract

Objective: To delineate the clinical and demographic characteristics of non-rheumatic aortic valve disease (NRAVD) by treatment modalities, and to evaluate factors that increase the risk of infective endocarditis in inpatients with NRAVD. Methods: A retrospective cross-sectional study was performed with a total of 109,000 adult patients (age 18-90 years) primarily managed for NRAVD selected from the nationwide inpatient sample (NIS, 2019) in the United States. The study sample was divided based on treatment into medical therapy vs. transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Alogistic regression model was used to evaluate the odds ratio (OR) of the association for infective endocarditis in inpatients with NRAVD. Results:Ahigher prevalence of infective endocarditis was recorded in SAVR (1.1%) compared to the inpatients managed with medical therapy (0.8%) and TAVR (0.1%). Patients with major loss of body functioning were managed in higher proportions with SAVR (42.8%) and medical therapy (41.9%) instead of TAVR (30.2%). In-hospital mortality was higher in medical therapy (4.1%) compared to SAVR (2.1%) and TAVR (1.2%). The risk of infective endocarditis was signicantly higher in patients with NRAVD <65 years of age (OR 2.85), whites (OR 1.62), hypertension (OR 1.61), and drug abuse (OR 3.49). Conclusion: The likelihood of IE increases in younger patients with comorbid hypertension and drug abuse, and major loss of body functioning. A higher proportion of the inpatients managed with SAVR had IE compared to those with TAVR and medical therapy. Longitudinal studies are required to assess the risk and outcomes of related to the treatment for NRAVD