Treatment of Endocarditis: A Decade of Experience

Background: Endocarditis represents a small proportion of cardiovascular disease but is associated with high mortality. Previous studies have reported a range of outcomes, and determinants of mortality remain poorly defined. Methods: The goal of this retrospective study was to identify independent variables for early and late mortality in 364 consecutive patients with endocarditis over a 10-year period. Results: The mean age of patients was 48.2 years, 35% had a history intravenous drug use, 19.8% were reoperative, and 93% had native valve endocarditis. Fever (68%) and fatigue (36%) were the most common presenting symptoms, and congestive heart failure (52%), embolization (45%), and uncontrolled sepsis (36%) were the most common indications for surgery. Overall survival at discharge, 1, 5, and 10 years was 87%, 76%, 55%, and 31%, respectively. Survival at discharge, 5, and 10 years was 91%, 69%, and 41% for surgical patients and 85%, 60%, and 31% for medically treated patients, respectively. Surgery was associated with improved short-term and long-term survival (p < 0.0.01). Independent predictors of early death were hemodynamic instability (p = 0.013) and age older than 55 years (p < 0.025). Medical treatment (p = 0.005), age older than 55 years (p = 0.032), institution (p < 0.001), New York Heart Association functional class III or IV (p = 0.002), and hemodynamic instability (p = 0.044) were predictive of late death. Conclusions: Short-term and long-term mortality from endocarditis remains high, although surgically treated patients had improved survival. Differing outcomes from two geographically similar institutions highlight the limitations of extrapolating risk factors between disparate patient populations.