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Short- and Long-term Outcomes of Medically Treated Isolated Left-Sided Endocarditis: A Retrospective Study With 5-Year Longitudinal Follow-up
- Source :
- Canadian Journal of Cardiology. 36:1534-1540
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- A retrospective study of medically treated isolated left-sided infective endocarditis (LSIE) patients identifying predictors of outcomes with nonoperative management was undertaken.Medical records of 135 Manitoban medically managed LSIE patients from January 2004 to December 2016 were reviewed. Five-year survival for 135 patients and hospitalization data till March 2016 for 65 patients were collected from the Manitoba Centre for Health Policy.In-hospital mortality was 44%. Patients with surgical indications were more likely to die in-hospital than those without (53% vs 24%; P = 0.002). Survival at 1 and 5 years was 43% and 23%, respectively. All-cause readmission at 1 and 5 years was 64% and 84%, respectively. At 1 and 5 years, readmission from major adverse events (heart failure, stroke, endocarditis) was 25% and 47%, and from recurrent endocarditis was 17% and 26%, respectively. Severe valvular regurgitation was a risk factor for in-hospital mortality (odds ratio, 3.52; P = 0.022), poor long-term survival (hazard ratio [HR], 2.57; P0.001), and recurrent endocarditis (HR, 5.93; P 0.001). Prosthetic valve endocarditis was a risk factor for poor long-term survival (HR, 2.11; P = 0.002). Streptococcus viridans group was associated with better rates of in-hospital mortality (odds ratio, 0.28; P = 0.018) and long-term survival (HR, 0.34; P0.001).Nonoperative management of LSIE carries a poor prognosis but may have a role in select cases. Surgical management remains the mainstay for patients with clear surgical indications, including severe regurgitation and prosthetic valve endocarditis. Further prospective analyses are required to better delineate appropriate patient selection for nonsurgical management.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
Endocarditis
Hospital Mortality
030212 general & internal medicine
Risk factor
Stroke
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Medical record
Hazard ratio
Manitoba
Retrospective cohort study
Endocarditis, Bacterial
Odds ratio
Middle Aged
Prognosis
medicine.disease
Anti-Bacterial Agents
Survival Rate
Infective endocarditis
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 0828282X
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- Canadian Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....0c75d7b2fdab1312b80d83d1eb4de150