The value of an “Endocarditis Team”

Abstract

Establishment of the Heart Team concept in the field of cardiovascular medicine has resulted in quality improvement in the management of heart valve disease and heart failure. Similarly, the concept of an Endocarditis Team would be important in improving outcomes in patients with infective endocarditis (IE),given it is an uncommon clinical entity with general practitioners and low-volume centers lacking sufficient experience in its management. A multidisciplinary approach can substantially reduce the still unacceptably high morbidity and mortality in patients with IE, as it allows early diagnosis and appropriate comprehensive management. Decision-making within the Endocarditis Team must follow a standard protocol that is based on current clinical guidelines for the management of IE. If surgery is indicated, it is best performed sooner than later in most instances. Communication between referring hospitals and reference centers with an established Endocarditis Team must be smooth and definite protocols for transfer to experienced endocarditis centers with surgical facilities is essential. Follow-up and outpatient care following hospital discharge is crucial due to the possibility of residual infection and risk of development of recurrent endocarditis or heart failure, particularly within the first 2 years. Patient and health-care provider education is the mainstay for the accurate implementation of the Endocarditis Team concept. The following Keynote Lecture offers an overview of the current literature supporting the multidisciplinary management of IE and addresses multiple aspects related to the Endocarditis Team, highlighting its importance and necessity for the comprehensive treatment of this complex disease.

Heart teams in the Netherlands: From teamwork to data‑driven decision-making

“…Newer imaging techniques, such as high-resolution cardiac CT and 3D echocardiography, contribute to better decision-making but their interpretation requires specific expertise. Strict guidelines for the information required to enter the process and objective interpretation of images based on algorithms and machine learning can prevent wasting time debating the interpretation and the need to assemble all the experts [4][5][6][7]. Possibilities include image recognition, natural language processing and decision support systems [19].…”

Implementation of the 2015 European Society of Cardiology guidelines for the management of infective endocarditis in the Netherlands

“…Advanced imaging techniques-as described above-may not only be helpful in the detection of endocardial lesions when added to echocardiography, but also in establishing the presence of (clinically silent) vascular phenomena such as embolic events and infectious aneurysm [13]. Acknowledging this, the most recent ESC guidelines have added the identification of paravalvular lesions by CT and, in the setting of PVE, abnormal activity near the site of the prosthesis on 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT or radiolabelled leucocyte single photon emission computed tomography (SPECT)/CT, as a 'major' criterion for IE. The currently applicable two major and five minor criteria for IE are described in Tab.…”

“…2. Examples of pos- itive echocardiogram, 18 F-FDG PET/CT and cardiac CT are demonstrated in Fig. 3.…”

“…Such a team, comprising-at least-a cardiologist, cardio-thoracic surgeon, infectious diseases specialist, microbiologist and radiologist/nuclear medicine physician should provide the expertise needed to treat complex IE patients. The guidelines refer-among other things-to the team approach adopted in France, with standardised medical therapy and uniform recommendations for surgical interventions that were found to improve outcome relative to earlier experience [14][15][16][17][18]. A comparable recommendation has been made in the AHA/ACC guidelines for the management of patients with valvular disease [19].…”

Blood culture negative endocarditis in the modern era of 16S rRNA sequencing

“…Delayed diagnosis prevents active management with optimal antimicrobial therapy, early involvement from a multidisciplinary endocarditis team and individualised patient management including early surgery which have all been shown to significantly improve outcomes. 12 Most cases of endocarditis are caused by bacterial infection and usually the diagnosis is made by culture-dependent methods. Uncertainty about the causative organism may result in inadequate treatment, exposure of the patient to potentially toxic empirical treatment and ultimately affect outcome.…”