Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 29;22(1):338.
doi: 10.1186/s12872-022-02761-z.

Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality-a nationwide study

Andreas Dalsgaard Jensen  1 , Lauge Østergaard  2   3 , Jeppe K Petersen  2 , Peter Graversen  2 , Jawad H Butt  2 , Henning Bundgaard  2   4 , Claus Moser  5 , Morten H Smerup  6   4 , Ivy S Modrau  7 , Kasper Iversen  8   4 , Niels E Bruun  9 , Christian Torp-Pedersen  10   11   12   4 , Gunnar Gislason  13   14   4 , Andrew Wang  15 , Sigurdur Ragnarsson  16 , Jonas A Povlsen  17 , Lars Køber  2   4 , Emil L Fosbøl  2
Affiliations

Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality-a nationwide study

Andreas Dalsgaard Jensen et al. BMC Cardiovasc Disord. .

Abstract

Background: Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist.

Methods: We included patients with first-time IE (1999-2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999-2003, 2004-2008, 2009-2013, 2014-2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression.

Results: We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999-2003 to 2014-2018. Compared with 1999-2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96-1.35), OR = 1.20 (95% CI: 1.02-1.42), and OR = 1.10 (95% CI: 0.93-1.29) in 2004-2008, 2009-2013, and 2014-2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999-2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65-1.41), HR = 0.43 (95% CI: 0.28-0.67), and HR = 0.55 (95% CI 0.37-0.83) in 2004-2008, 2009-2013, and 2014-2018, respectively.

Conclusions: On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased.

Keywords: Cardiac valve surgery; Epidemiology; Infective endocarditis; Temporal trend.

PubMed Disclaimer

Conflict of interest statement

Henning Bundgaard: Speakers honorarium from Amgen unrelated to this manuscript. Claus Moser: Independent research grant from the Novo Nordisk Foundation, unrelated to this manuscript. Ivy Susanne Modrau: Independent research grants from the Health Research Foundation of Central Denmark Region, unrelated to this manuscript. Niels Eske Bruun: Independent research grants from the Novo Nordisk Foundation, and from the regions of Southern Denmark and Zealand, unrelated to this manuscript. Christian Torp-Pedersen: Grants from Novo Nordisk and Bayer,unrelated to this manuscript. Andrew Wang: Legal expert for case of infective endocarditis (defendant), unrelated to this manuscript. Lars Køber: Speakers honorarium from Novo, Novartis, AstraZeneca and Boehringer, unrelated to this manuscript. Emil Loldrup Fosbøl: Independent research grants from the Novo Nordisk Foundation and the Danish Heart Association. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion. Percentage marked with “*” is calculated as the number of patients with valve surgery per calendar period relative to the total number of patients per calendar period
Fig. 2
Fig. 2
Number of IE-patients and valve surgery during admission. The figure shows the total number of patients with first-time IE with/without surgery during admission. Furthermore, the figure shows the proportion of patients with IE who undergo surgery during admission (in %) as well as the postoperative mortality (30 days, Kaplan–Meier estimates, in %)
Fig. 3
Fig. 3
The figure shows the proportion of patients with IE who underwent surgery during their admission by calendar-year by the age groups < 40 years, 40–64 years, 65–75 years, > 75 years. IE: Infective endocarditis
See this image and copyright information in PMC

References

    1. Olmos C, Vilacosta I, Fernandez-Perez C, Bernal JL, Ferrera C, Garcia-Arribas D, et al. The evolving nature of infective endocarditis in Spain: a population-based study (2003 to 2014) J Am Coll Cardiol. 2017;70(22):2795–2804. doi: 10.1016/j.jacc.2017.10.005. - DOI - PubMed
    1. Cresti A, Chiavarelli M, Scalese M, Nencioni C, Valentini S, Guerrini F, et al. Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study. Cardiovasc Diagn Ther. 2017;7(1):27–35. doi: 10.21037/cdt.2016.08.09. - DOI - PMC - PubMed
    1. Leone S, Ravasio V, Durante-Mangoni E, Crapis M, Carosi G, Scotton PG, et al. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian study on endocarditis. Infection. 2012;40(5):527–535. doi: 10.1007/s15010-012-0285-y. - DOI - PubMed
    1. Bor DH, Woolhandler S, Nardin R, Brusch J, Himmelstein DU. Infective endocarditis in the U.S., 1998–2009: a nationwide study. PLoS ONE. 2013;8(3):e60033. doi: 10.1371/journal.pone.0060033. - DOI - PMC - PubMed
    1. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European society of cardiology (ESC) endorsed by: European association for cardio-thoracic surgery (EACTS), the European association of nuclear medicine (EANM) Eur Heart J. 2015;36(44):3075–3128. doi: 10.1093/eurheartj/ehv319. - DOI - PubMed