title: Better prognosis of elderly patients with infectious endocarditis in the era of routine echocardiography and nonrestrictive indications for valve surgery.
abstract: OBJECTIVE
  It has been reported that endocarditis in the elderly may have a poor outcome. Our aim was to assess the different features and prognosis, if any, in the present time.
  
  
  METHODS
  Of 103 patients with proven endocarditis, 31 were 65 years or older and 72 were younger than 65 years. Degenerative heart disease was seen more frequently in the elderly (22.5% vs 2.7%, P =.003). Drug abuse and immunodeficiency virus infection were more common in the younger group, as was tricuspid endocarditis (26.3% vs 0%, P <.001). At clinical presentation cardiac failure (41.9 vs 19.4%, P =.02) and leukocytosis (61.2% vs 40.2%, P =.049) were seen more frequently in the elderly.
  
  
  RESULTS
  Despite other similar clinical features, it took longer to diagnose older patients (7.2 +/- 6.2 vs 3.2 +/- 3.5 days, P <.001). Enterococcus infected the aged more often (32.2% vs 13.1%, P =.001). During hospitalization, heart failure and embolization tended to be more common in the elderly and the younger group, respectively. There were no significant differences in the incidence of anatomic complications, the need for operation, and overall mortality.
  
  
  CONCLUSIONS
  Although a worse prognosis has been reported in elderly patients with infective endocarditis, the early use of transesophageal echocardiographic examinations and equal therapeutic options provides a similar outcome when compared with younger subjects.
authors.affiliation: Echocardiography Laboratory of the Hospital Clínico San Carlos, Madrid, Spain. jlzamorano@jet.es
authors.forename: José
authors.initials: J
authors.lastname: Zamorano
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: Carlos
authors.initials: C
authors.lastname: Almería
authors.forename: José Luis
authors.initials: JL
authors.lastname: Rodrigo
authors.forename: Ester
authors.initials: E
authors.lastname: de Marco
authors.forename: Viviana
authors.initials: V
authors.lastname: Serra
authors.forename: Miriam
authors.initials: M
authors.lastname: Samedi
authors.forename: Luis
authors.initials: L
authors.lastname: Sánchez-Harguindey
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis