title: High readmission rates and mental distress after infective endocarditis - Results from the national population-based CopenHeart IE survey.
abstract: BACKGROUND
  Infective endocarditis (IE) is a severe disease requiring lengthy hospitalisation. Little is known about patients' recovery after IE. The aims of this study in IE patients were; (i) to describe mortality, readmission, self-reported health and rehabilitation up to 1year post-discharge, (ii) to examine associations between self-reported health and readmission, and (iii) to investigate predictors of readmission and mortality.
  
  
  METHODS
  All adults treated for IE in Denmark, January-June 2011 (N=347), were followed in registers. Eligible individuals (n=209) were invited to participate in a questionnaire survey (responders n=122). Responses were compared with those of a background reference population and a heart valve surgery population. Mortality and readmission data from registers 12months post-discharge were investigated.
  
  
  RESULTS
  Patients discharged after treatment for IE had a mortality of 18% (95% confidence interval (CI): 14%-23%) one year post-discharge and 65% (95% CI: 59%-71%) had been readmitted, the majority (82%) acutely. Patients had lower self-reported health compared to the background population (physical component scale (PCS); mean (standard deviation (SD)): 42.2 (11.1) vs. 47.1 (12.1), (p=0.0004), mental component scale (MCS); 50.1 (11.7) vs. 53.8 (9.2), (p=0.006), and more were sedentary (29 vs. 15%), (p=0.002). Large proportions had clinical signs of anxiety and depression, 25% and 22% respectively, exceeding a hospital anxiety and depression scale (HADS) cut-off score of 8. Almost half (47%) had not been offered cardiac rehabilitation (CR).
  
  
  CONCLUSIONS
  After IE, mortality and readmission rates were high and self-reported physical and mental health poor. These findings call for changes in in-hospital and post-discharge management.
authors.affiliation: The Heart Centre (Section 2151), Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Department of Cardiology (Section SA-835), Herlev and Gentofte University Hospital, Kildegårdsvej 28, 2900 Hellerup, Denmark. Electronic address: trine.bernholdt.rasmussen@regionh.dk.
authors.forename: Trine Bernholdt
authors.initials: TB
authors.lastname: Rasmussen
authors.affiliation: National Centre of rehabilitation and palliation, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark. Electronic address: ann.dorthe.olsen.zwisler@rsyd.dk.
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen K, Denmark. Electronic address: lct@si-folkesundhed.dk.
authors.forename: Lau Caspar
authors.initials: LC
authors.lastname: Thygesen
authors.affiliation: The Heart Centre (Section 2151), Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark. Electronic address: henning.bundgaard@regionh.dk.
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
authors.affiliation: KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, blok D, box 7001, 3000 Leuven, Belgium; Institute of Health and Care Science, University of Gothenburg, Arvid Wallgrens backe 20, 41346 Gothenburg, Sweden. Electronic address: philip.Moons@med.kuleuven.be.
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.affiliation: The Heart Centre (Section 2151), Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark. Electronic address: selina.kikkenborg.berg.01@regionh.dk.
authors.forename: Selina Kikkenborg
authors.initials: SK
authors.lastname: Berg
mesh_terms: D000328:Adult; D000072038:Cardiac Rehabilitation / Q000379:methods / Q000592:standards; D003718:Denmark / Q000453:epidemiology; D004696:Endocarditis / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D020380:Needs Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D000071066:Patient Reported Outcome Measures; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis
keywords: Endocarditis; Mortality; Patient outcome assessment; Patient readmission; Quality of life; Rehabilitation