Increasing incidence and mortality of infective endocarditis: a population-based study through a record-linkage system

Abstract

BackgroundFew population-based studies provide epidemiological data on infective endocarditis (IE). Aim of the study is to analyze incidence and outcomes of IE in the Veneto Region (North-Eastern Italy).MethodsResidents with a first hospitalization for IE in 2000-2008 were extracted from discharge data and linked to mortality records to estimate 365-days survival. Etiology was retrieved in subsets of this cohort by discharge codes and by linkage to a microbiological database. Risk factors for mortality were assessed through logistic regression.Results1,863 subjects were hospitalized for IE, with a corresponding crude rate of 4.4 per 100,000 person-years, increasing from 4.1 in 2000-2002 to 4.9 in 2006-2008 (p = 0.003). Median age was 68 years; 39% of subjects were hospitalized in the three preceding months. 23% of patients underwent a cardiac valve procedure in the index admission or in the following year. Inhospital mortality was 14% (19% including hospital transfers); 90-days and 365-days mortality rose through the study years. Mortality increased with age and the Charlson comorbidity index, in subjects with previous hospitalizations for heart failure, and (in the subcohort with microbiological data) in IE due to Staphylococci (40% of IE).ConclusionsThe study demonstrates an increasing incidence and mortality for IE over the last decade. Analyses of electronic archives provide a region-wide picture of IE, overcoming referral biases affecting single clinic or multicentric studies, and therefore represent a first fundamental step to detect critical issues related to IE.

Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study

“…Sampling from different populations at risk, diverse diagnostic criteria, inclusion of cases with diagnosis of "possible" IE and referral bias may explain the wide range of incidence rates reported, even in the same country, from 1 to 15 cases per 100,000 per year. A wide range of global mortality is reported too, from 4% to 48% and temporal trend analyses describe an increasing incidence of IE, without a decrease in mortality rate, but these data need confirmation (18). Among population-based studies, discordant data are also present in the percentage of surgically treated patients that ranges from 12.8% to 49% (13).…”

Mycotic aneurysm as a complication of infective endocarditis - a case report

“…5 The long period of hospitalization of the patient (nearly 100 days) may be explained by the occurrence of cerebral hemorrhage, corroborated by the study conducted in northeastern Italy, which demonstrates an increase in the average hospitalization from 23 to 35 days in the presence of complications associated with IE. 17 Despite this, like the majority of survivors of cerebrovascular events secondary to IE evaluated by the study by Yeates, the patient recovered well from her neurological impairments. 15 references…”

NVS and Staphylococci in the Oral Cavity – A Cause of Infective Endocarditis

“…The changing spectrum from streptococci to staphylococci has been reported in recent epidemiological studies performed in many countries (Sandre & Shafran, 1996;Hoen et al, 2002;Cecchi et al, 2004, Ferreiros et al, 2006Alshammary et al, 2008;Fedeli et al, 2011). S. aureus has also been identified as a leading cause of death cases (Alshammary, et al, 2008;Yoshinaga et al, 2008).…”

“…The overall incidence rate has been found to range from 4.4 to 11.6 cases per 100,000 person-years (Berlin et al, 1995;Tleyjeh et al, 2005;Fedeli et al, 2011). Cardiac valvular abnormalities that cause eddy-or jet-type vascular flow are strong risk factors (Strom et al, 1998;Nakatani et al, 2003).…”