Infective endocarditis in Europe: lessons from the Euro heart survey

Abstract

Objectives: To describe the characteristics, treatment, and outcomes of active infective endocarditis (IE) in Europe. Design: Prospective survey of medical practices in Europe. Setting: 92 centres from 25 countries. Patients: The EHS (Euro heart survey) on valvar heart disease (VHD) enrolled 5001 adult patients between April and July 2001. Of those, 159 had active IE. Results: 118 patients (74%) had native IE and 41 (26%) had prosthetic IE. Mean (SD) age was 57 (16) years. Blood cultures were obtained for 113 patients (71%) before antibiotic treatment was started. Surgery was performed in 52% of patients. Reasons for surgery were heart failure in 60%, persistent sepsis in 40%, vegetation size in 48%, or embolism in 18%. Surgery was for implantation of mechanical prosthesis in 63%, bioprosthesis in 21%, aortic homograft in 5%, and valve repair in 11%. In-hospital mortality was 12.6%, being 10.4% in the medical group and 15.6% in the surgical group. Among the total population of 5001 patients, only 50% of those with native VHD had been educated on endocarditis prophylaxis and only 33% regularly attended dental follow up. Of patients with IE who had had a procedure at risk during the preceding year only 50% had received adequate prophylaxis. Conclusions: The EHS on VHD shows that patients with active IE have a high risk profile and often undergo surgery. However, there are deficiencies in obtaining blood cultures and applying prophylaxis. Mortality remains high, which is a justification for the improvement of patient management through education and the implementation of guidelines.

Changing Trends of Infective Endocarditis in India: A South Indian Experience

“…Studies from the West have shown early surgical intervention to be associated with reduced mortality. [20][21][22] More aggressive and early surgical intervention as has been advocated in many reviews may have improved the outcome and this change in clinical practice is perhaps the need of the hour in developing countries. Our study has certain limitations.…”

“…The clinical presentation of IE started showing features more commonly seen in the developed countries: a higher mean age at presentation and an increase in prosthetic valve endocarditis. [1][2][3] Streptococcal species remain the commonest causative organisms. The increase in age by a decade at presentation of IE is an important positive finding of this study.…”

“…In industrialized countries, more than 50% with IE have normal heart valves, while less than 10% have rheumatic heart disease. [1][2][3] Three previous studies from India have shown rheumatic heart disease (RHD) to be the most common underlying cardiac condition for IE in the developing world (40-45%). [4][5][6] However, the prevalence of RHD in India has decreased significantly over the past few decades.…”

Profile of infective endocarditis cases at a tertiary hospital in Turkey: our 15-year experience

“…[2] According to data collected in the Euro Heart Survey study, the mean age of patients at IE onset was 56±17 years in Europe, while a study performed in Greece, one of Turkey's neighbor countries, reported a mean age of 54±17 years. [11,12] The mean age of patients at IE onset is as low as 32 years in countries such as Tunisia and India. [13,14] Studies performed in Turkey in different time points reported the mean age at disease onset varying between 45 and 47 years.…”

Endocarditis infecciosa

“…La insuficiencia cardíaca, que se presenta en 50 % a 60 % de los pacientes con EI, es la causa más frecuente de indicación quirúrgica (29); usualmente se debe al daño valvular agudo, con la insuficiencia correspondiente; en 29 % de los casos se afecta la válvula aórtica y en 20 %, la mitral (34). Las fístulas o la obstrucción de las cavidades cardíacas por vegetaciones gigantes son causas menos frecuentes de falla cardíaca.…”