Excess mortality and morbidity in patients surviving infective endocarditis.
BACKGROUND
Mortality and morbidity associated with infective endocarditis may extend beyond successful treatment. The primary objective was to analyze rates, temporal changes, and predictors of excess mortality in patients surviving the acute phase of endocarditis. The secondary objective was to determine the rate of recurrence and the need for late cardiac surgery.


METHODS
An observational cohort study was conducted at a university-affiliated tertiary medical center, among 328 patients who survived the active phase of endocarditis. We used age-, sex-, and calendar year-specific mortality hazard rates of the Bouches-du-Rhone French district population to calculate expected survival and excess mortality. The risk of recurrence and late valve surgery was also assessed.


RESULTS
Compared with expected survival, patients surviving a first episode of endocarditis had significantly worse outcomes (P = .001). The relative survival rates at 1, 3, and 5 years were 92% (95% CI, 88%-95%), 86% (95% CI, 77%-92%), and 82% (95% CI, 59%-91%), respectively. This excess mortality was observed during the entire follow-up period but was the highest during the first year after hospital discharge. Most of the recurrences and late cardiac surgeries also occurred during this period. Women exhibited a higher risk of age-adjusted excess mortality (adjusted excess hazard ratio, 2.0; 95% CI, 1.05-3.82; P = .03). Comorbidity index, recurrence of endocarditis, and history of an aortic valve endocarditis in women were independent predictors of excess mortality.


CONCLUSIONS
These results justify close monitoring of patients after successful treatment of endocarditis, at least during the first year. Special attention should be paid to women with aortic valve damage.
Département de Cardiologie, Hôpital La Timone, Aix-Marseille Université, Marseille, France. franck.thuny@gmail.com
Franck
F
Thuny
Roch
R
Giorgi
Raja
R
Habachi
Sebastien
S
Ansaldi
Yvan
Y
Le Dolley
Jean-Paul
JP
Casalta
Jean-François
JF
Avierinos
Alberto
A
Riberi
Sebastien
S
Renard
Frederic
F
Collart
Didier
D
Raoult
Gilbert
G
Habib
D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate