Influence of a multidisciplinary alert strategy on mortality due to left-sided infective endocarditis.
OBJECTIVE
Mortality from left-sided infective endocarditis remains very high. The aim of this study was to assess the impact of a multidisciplinary alert strategy (AMULTEI), based on clinical, echocardiographic and microbiological findings, implemented in 2008 in a tertiary hospital.


METHODS
Cohort study comparing our historical data series (1996-2007) with the number of patients diagnosed with left-sided endocarditis from 2008-2011 (AMULTEI).


RESULTS
The AMULTEI cohort included 72 patients who were compared with 155 patients in the historical cohort. AMULTEI patients were significantly older (62.5 vs 57.9 years in the historical cohort; P=.047) and had higher comorbidity (Charlson index, 3.33 vs 2.58 in the historical cohort; P=.023). There was also a trend toward more enterococcal etiology in the AMULTEI group (20.8% vs 11.6% in the historical cohort; P=.067). In the AMULTEI group, early surgery was more frequently performed (48.6% vs 23.2%; P<.001) during hospitalization, the incidence of septic shock was significantly lower (9.7% vs 24.5%; P=.009) and there was a trend toward reductions in neurological complications (19.4% vs 29.0%; P=.25) and severe heart failure (12.5% vs 18.7%; P=.24). In-hospital mortality and mortality during the first month of follow-up were significantly lower in the AMULTEI group (16.7% vs 36.1%; P=.003).


CONCLUSIONS
Despite the trend toward older age and more comorbidity measured by the Charlson index, early mortality was significantly lower in patients treated with the AMULTEI strategy.
Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Electronic address: fernandocarrascochinchilla@gmail.com.
Fernando
F
Carrasco-Chinchilla
Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Gemma
G
Sánchez-Espín
Unidad de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Spain.
Josefa
J
Ruiz-Morales
Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Isabel
I
Rodríguez-Bailón
Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Jose M
JM
Melero-Tejedor
Unidad de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Spain.
Rada
R
Ivanova-Georgieva
Unidad de Microbiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Victoria
V
García-López
Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Antonio
A
Muñoz-García
Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Juan J
JJ
Gómez-Doblas
Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
Eduardo
E
de Teresa-Galván
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011446:Prospective Studies
Complicaciones; Complications; Echocardiography; Ecocardiografía; Endocarditis