Abstract 13821: Heart Failure Complicating Infective Endocarditis: An Analysis of In-Hospital Mortality from the International Collaboration on Endocarditis Prospective Cohort Study
Introduction: Heart failure (HF) is a well-recognized, serious complication of infective endocarditis (IE), but outcome of HF in IE is not well described.
Methods: We examined a cohort of 3,988 patients with definite native or prosthetic valve IE by modified Duke criteria from the International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS). Among patients with HF, univariate analysis of clinical, echocardiographic, and microbiologic data was performed to evaluate differences between in-hospital survivors vs. deaths. Multivariate logistic regression analysis was performed to identify variables independently associated with in-hospital mortality in IE complicated by HF.
Results: 1,319 patients (32%) with definite IE were reported to have HF, including 876 patients (66%) classified as NYHA class III or IV and 814 (62%) patients who underwent valve surgery. In-hospital mortality was 29.3% in the overall HF cohort; patients undergoing valve surgery had lower in-hospital mortality compared to HF patients not treated with surgery (20.3% vs. 44.4%, respectively; p<0.001). In-hospital death was also associated (p<0.001) with age >70 years, history of diabetes mellitus, health care-associated infection, mitral valve vegetation, stroke, NYHA class III or IV HF, persistent positive blood cultures, and S. aureus causation. Multivariate logistic regression analysis (Table) demonstrated that NYHA class III or IV HF, age >70 years, diabetes mellitus, stroke, and paravalvular complications independently predicted in-hospital mortality, while surgery during index hospitalization was associated with a survival benefit.
Conclusion: More than one-third of patients with HF in IE do not undergo cardiac surgery during index hospitalization and experience a very high in-hospital mortality rate. In addition, host factors and complications of IE strongly influence survival of patients with HF in IE.
- © 2010 by American Heart Association, Inc.