Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis

Abstract

IntroductionPatients leaving against medical advice (AMA) are commonly encountered in hospital medicine. The problem is prevalent worldwide and across all fields of medicine. A retrospective study of 47,583 patients reported a 3.3% AMA rate in 2015.ObjectivesIn this retrospective study, we aimed (1) to study the demographic, clinical, and laboratory parameters of infective endocarditis (IE) patients leaving AMA. We also compared (2) the various risk factors and outcomes of these patients with IE patients who completed treatment.ResultsA total of 111 patients diagnosed with IE were recruited for 36 months. Of the 74 patients with available details, 32 patients (29%) left AMA during their treatment. The mean age of patients leaving AMA was 39, and among those who left AMA, 66% were females. As compared with patients completing therapy, patients leaving AMA tend to have higher comorbidities, including injection drug use (68.1% versus 31.9%), prior IE (83.3% versus 16.7%), and chronic hepatitis C (72.4% versus 27.8%). Rates of consumption of substances of abuse were higher among those who left AMA. Patients leaving AMA also had higher psychiatric comorbidities (63% versus 37.5%), history of leaving AMA (70.5% versus 29.5%), and consumption of more than 2 substances of abuse. Morbidity was higher in patients leaving AMA. There was a statistically significant association between the development of distal embolus (P < 0.001), the need for recurrent admissions (P = 0.002), recurrent bacteremia (P < 0.001), developing new embolus (P < 0.001), and overall morbidity (P = 0.002) among IE patients leaving AMA.ConclusionsInfective endocarditis patients leaving AMA tend to be younger females. These patients have prior comorbidities of injection drug use, prior IE, multiple psychiatric comorbidities, drug use, and multiple socioeconomic issues. Patients leaving AMA tend to develop further non–Central nervous system embolic events, recurrent bacteremia, and require frequent admissions. Morbidity in these patients was higher.

Coronary artery mycotic aneurysm in a patient suffering from subacute endocarditis: a case report and literature review

“…In view of pathophysiology, the available evidence suggests IE as the source in most cases of CAMA (5,6,10), which predisposes the patients to other complications, such as hemorrhagic and embolic (cerebrovascular) events (11). Stent implantation in coronary arteries is also frequently reported as an important source of bacteremia and bacterial seeding, resulting in CAMA; but our patient had no history of previous coronary stenting and neither was immunocompromised to be further predisposed to any possible systemic infection as the cause of CAMA; therefore, his coronary infection can be attributed to endocarditis because of the bicuspid aortic valve and direct extravalvular extension of IE or possible bacterial seeding of the proximal coronary artery, secondary to valvular involvement by IE.…”

Cardiovascular complications following medical termination of pregnancy: An updated review

“…All the reports of SCAD and TTC consistently did not report cardiac catheterization results[ 80 ]. Reports did not mention functional status at discharge, recurrence, and long-term follow-up details[ 81 - 84 ]. However, the strengths of this study are: (1) Having a strict inclusion criterion for each clinical entity; and (2) Evidence-based detailing on the clinical profile and the outcome of each described complication.…”

A Bayesian network-based approach for identifying risk factors and predicting ischemic stroke in infective endocarditis patients

“…and quality of life. The risk factors for ischemic and hemorrhagic stroke include male sex, older age, prior IE or stroke, S. aureus infection, fungal infection, atrial fibrillation, multiple vegetation, mitral valve vegetation, valvular abscess, large vegetation (>10 mm), and rheumatic heart disease (4,(7)(8)(9)(10). Although predictive models (e.g., ER French Calculator) have been proposed to assess the risk of embolic events in IE patients, they lack external validation (11,12).…”