Effects of changes in management of active infective endocarditis on outcome in a 25-year period.
The clinical outcome and long-term follow-up of 130 consecutive patients (141 episodes) with active infective endocarditis who were treated between 1966 and 1991 were analyzed. There was a shift toward a higher proportion of referred patients (39 to 78%), patients aged > 60 years (11 to 41%) and urgent surgical treatment (11 to 44%). Medical treatment was administered in 98 patients (70%); 30-day mortality was 27%. Surgery was performed in 43 patients (30%), with an operative mortality of 26%; 9 of 14 patients (64%) who underwent operation within the first week of admission died. Patients with severe heart failure are at the highest risk for early mortality (relative risk = 21.1; 95% confidence interval 7.4-60.3). Referred patients were much more often treated surgically than were nonreferred patients (48 versus 14%) and had a lower operative mortality (24 vs 30%). Nonreferred patients were more often treated medically (86 vs 52%) and with lower mortality (19 vs 39%). The total follow-up time was 730 patient-years; only 1 patient was considered lost to follow-up. The overall cumulative 5-year and 10-year survival after hospital discharge for patients after urgent surgery were 84 +/- 7% and 53 +/- 7%, respectively, and for those after medical treatment 84 +/- 5% and 77 +/- 6%, respectively. The probability of remaining free of late events (recurrent endocarditis, late valve replacement or death) during 5 and 10 years for patients after urgent surgery was 84 +/- 7% and 53 +/- 15%, respectively, and for those after medical treatment 59 +/- 6% and 40 +/- 7%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Verheul
H A
HA
Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
van den Brink
R B
RB
van Vreeland
T
T
Moulijn
A C
AC
Düren
D R
DR
Dunning
A J
AJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000473:pathology; D002303:Cardiac Output, Low / Q000382:microbiology / Q000601:surgery; D002423:Cause of Death; D002985:Clinical Protocols; D004617:Embolism / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D011654:Pulmonary Edema / Q000382:microbiology / Q000601:surgery; D012017:Referral and Consultation; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents