title: Long-term clinical outcome of major adverse cardiac events in survivors of infective endocarditis: a nationwide population-based study.
abstract: BACKGROUND
  Substantial infective endocarditis (IE)-related morbidity and mortality may occur even after successful treatment. However, no previous study has explored long-term hard end points (ie, stroke, myocardial infarction, heart failure, cardiovascular death) in addition to all-cause mortality in IE survivors.
  
  
  RESULTS
  A nationwide population-based cohort study was conducted among IE survivors identified with the use of the Taiwan National Health Insurance Research Database during 2000 to 2009. IE survivors were defined as those who survived after discharge from first hospitalization with a diagnosis of IE. A total of 10 116 IE survivors were identified. IE survivors were matched to control subjects without IE at a 1:1 ratio through the use of propensity scores. The primary outcomes were stroke, myocardial infarction, readmission for heart failure, and sudden cardiac death or ventricular arrhythmia. The secondary outcomes were repeat IE and all-cause mortality. Compared with the matched cohort, IE survivors had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.59; 95% confidence interval [CI], 1.40-1.80), hemorrhagic stroke (aHR, 2.37; 95% CI, 1.90-2.96), myocardial infarction (aHR, 1.44; 95% CI, 1.17-1.79), readmission for heart failure (aHR, 2.24; 95% CI, 2.05-2.43), sudden death or ventricular arrhythmia (aHR, 1.69; 95% CI, 1.44-1.98), and all-cause death (aHR, 2.27; 95% CI, 2.14-2.40). Risk factors for repeat IE were older age, male sex, drug abuse, and valvular replacement after an initial episode of IE.
  
  
  CONCLUSIONS
  Despite treatment, the risk of long-term major adverse cardiac events was substantially increased in IE survivors.
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Hsi
authors.initials: H
authors.lastname: Chu
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Chao
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Yang
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.).
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.). ytchen0117@gmail.com okokyytt@gmail.com.
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.affiliation: From the School of Medicine (C-J.S., H.C., Y-J.L., S.-C.K., S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O., Y.-T.C.) and Institute of Clinical Medicine (S.-M.O.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan (C.-J.S.); Division of Respiratory Medicine, Department of Chest (H.C.), and Division of Nephrology, Department of Medicine (Y.-T.C.), Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan; School of Medicine and Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (P.-W.C.); Department of Neurology, Neurological Institute (Y.-J.L.), Division of Infectious Diseases (S.-C.K.), and Division of Nephrology, Department of Medicine (S.-Y.L., D.-C.T., C.-Y.Y., W.-C.Y., S.-M.O.), Taipei Veterans General Hospital, Taipei, Taiwan; and National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan (S.-C.K.). ytchen0117@gmail.com okokyytt@gmail.com.
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004696:Endocarditis / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: endocarditis; epidemiology; heart failure; mortality; myocardial infarction; stroke