Impact of the COVID-19 Pandemic on Infective Endocarditis Management and Outcomes: Analysis of a National Clinical Database

Novelli, Alexandra; Ingason, Arnar B.; Jirka, Caroline; Callas, Peter; Hirashima, Fuyuki; Lovoulos, Constantinos; Dauerman, Harold L.; Polomsky, Marek

doi:10.1016/j.amjcard.2023.08.190

Cited by 1 publication

(2 citation statements)

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“…IE has high morbidity and mortality rates if not interceded early in its course, and healthcare crises, such as the COVID-19 pandemic, may exacerbate delays in diagnosis and treatment [22]. Indeed, in our population, we observed a statistically significant increase in the time elapsed between diagnosis of IE and intervention, without, however, an increase in in-hospital mortality.…”

Section: Discussionmentioning

confidence: 56%

“…On the other hand, the impact of the COVID-19 pandemic on the surgical treatment of IE is still uncertain. Indeed, Novelli et al [22] analyzed the national trends in admissions, demographics, and outcomes of IE before and after the onset of COVID-19, using a national sample of IE admissions between 2016 and 2022 from the Vizient Clinical Database. Only a small percentage of patients (14%) underwent surgery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Treatment of Active Endocarditis Pre- and Post-COVID-19 Pandemic Onset

Mikus,

Fiorentino,

Sangiorgi

et al. 2024

Biomedicines

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Background: Despite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. The impact of COVID-19 on the diagnosis and outcome of the surgical treatment of IE is uncertain. The aim of this study was to analyze the incidence, characteristics, and outcomes of surgically treated IE before and after the COVID-19 pandemic. Methods: This study retrospectively analyzed the data of 535 patients who underwent valve surgical procedures for IE between January 2010 and December 2022 in a single cardiac surgery center. Patients were divided into two groups depending on the date of their operation: before (n = 393) and after (n = 142) COVID-19 onset. In order to balance the groups, inverse probability of treatment weighting (IPTW) calculated from the propensity score (PS) was applied. Weighted univariate logistic regressions were reported for outcomes; weights were derived from IPTW. Interrupted time series analysis (ITSA) according to Linden’s method was used to evaluate the changes in the manifestation of IE after 11 March 2020. Results: Patients from the post-COVID-19 cohort (after 11 March 2020) had a greater number of comorbidities such as diabetes (29.6% vs. 16.3% p = 0.001), hypertension (71.1% vs. 59.5% p = 0.015), and preoperative kidney injury requiring dialysis (9.2% vs. 2.5% p = 0.002), but the median additive and logistic EuroSCORE were not statistically different. In the post-COVID-19 group, we observed a greater prevalence of Staphylococcus aureus-related endocarditis (24.5% vs. 15.4% p = 0.026), a consequent reduction in Staphylococcus non aureus-related endocarditis (12.2% vs. 20.1% p = 0.048), and a decrease in aortic valve replacements (43.0% vs. 53.9%), while the number of mitral valve replacements and repair was greater (21.1% vs. 15.0% and 6.3% vs. 4.3%, respectively). No differences were found in the two groups concerning early death, death, or relapse at 1 year after surgery. Data obtained by multivariable analysis identified preoperative renal dysfunction requiring dialysis as the only common risk factor for early mortality via stratifying by time periods in analysis. Conclusions: The incidence of surgically treated IE significantly increases after the COVID-19 pandemic with a higher incidence of mitral valve involvement with respect to the aortic valve. Although a delay in surgical timing occurred during the COVID-19 pandemic, data in terms of mortality and outcomes were largely unaffected.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%