title: Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis.
abstract: Strategies to improve management of patients with native valve endocarditis (NVE) are needed because of persistently high morbidity and mortality. We sought to assess the impact of an operative protocol of multidisciplinary approach on the outcome of patients with NVE. A formal policy for the care of infective endocarditis was introduced at our hospital in 2003 in which patients were referred to and managed by a preexisting team involving a cardiologist, a specialist in infectious diseases, and a cardiac surgeon. The initial multidisciplinary evaluation was performed within 12 hours of admission. Whenever conditions associated with impending hemodynamic impairment, high-risk for systemic embolization, or unsuccessful medical therapy were found, patients were operated on within 48 hours. Stable patients were evaluated weekly by the multidisciplinary team, and on-treatment surgery was performed whenever the above high-risk conditions had developed. Comparing the period 2003 through 2009 with 1996 through 2002 (when a multidisciplinary policy was not followed), patients were more numerous (190 vs 102), older (mean age 59.1 vs 54.2, p = 0.01), and had more co-morbidities (mean Charlson index 3.01 vs 2.31, p = 0.02). The pattern of infection did not change in terms of valve infected or paravalvular complications. In the second period, fewer patients had culture-negative NVE (8% vs 21%, p = 0.01) and worsened renal function (37% vs 58%, p = 0.001). A significant reduction in overall in-hospital mortality (28% to 13%, p = 0.02), mortality for surgery during the active phase (47% to 13%, p ≤0.001), and 3-year mortality (34% vs 16%, p = 0.0007) was observed. In conclusion, formalized, collaborative management led to significant improvement in NVE-related mortality, notwithstanding the less favorable patients' baseline characteristics.
authors.affiliation: Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy. Electronic address: fchirillo@tin.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Chirillo
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Scotton
authors.forename: Francesco
authors.initials: F
authors.lastname: Rocco
authors.forename: Roberto
authors.initials: R
authors.lastname: Rigoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Borsatto
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pedrocco
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Leo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Elvio
authors.initials: E
authors.lastname: Polesel
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
mesh_terms: D000368:Aged; D001021:Aortic Valve; D019468:Disease Management; D004452:Echocardiography / Q000379:methods*; D004696:Endocarditis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015996:Survival Rate / Q000639:trends