Abstract 14060: Impact of a Formalized Multidisciplinary Management Strategy on the Outcome of Patients With Infective Endocarditis
We sought to assess the impact of an operative protocol of multidisciplinary approach on the outcome of patients with infective endocarditis (IE). A formal policy for the care of IE was introduced at our hospital in 2003 so that patients were referred to and managed by a pre-existing team involving a cardiologist, a specialist in infectious diseases, and a cardiac surgeon. The initial multidisciplinary evaluation was performed within 12 hours of admission. Whenever conditions associated with impending hemodynamic impairment, high-risk for systemic embolization, and unsuccessful medical therapy were found, patients were operated within 48 hours. Stable patients were evaluated weekly by the multidisciplinary team and on-treatment surgery was performed whenever the above high-risk conditions had developed. Comparing the period 1 (2003–2008) vs. period 2 (1997–2002, when a multidisciplinary policy was not followed) patients were more numerous (196 vs 105), older (mean age 62 vs 57, p=0.01), and with more comorbidities (mean Charlson index 3.37 vs2.75, p=0.03). Oral Streptococci were less frequently (2.6% vs 12.4%, p<0.001) identified as causative agents. The pattern of infection did not alter in terms of valve infected, and subvalvular complications. Overall mortality declined from 22% to 13% (p= 0.04). Although the type of surgery did not change, the mortality rate in patients undergoing operation during the active phase of the disease significantly decreased during period 2 from 33 to 13% (p0.001). In the multivariate analysis failed antibiotic therapy (OR 11, 95%CI 4–32), multiorgan failure (OR 26, 95%CI 6–109) and the presence of abscess at echocardiography (OR 8, 95%CI 2–25) resulted independent predictors of in-hospital death. After adjustment for the patients' characteristics changed between the two periods, the treatment during period 2 remained independently predictive of in-hospital survival(OR 0.40, 95%CI 0.12–0.89, p=0.039). The beneficial effect remained when the calendar year was added to the Cox model (OR 0.42, 95%CI 0.09–0.94, p=0.042). In conclusion, a formalized collaborative management determined significant improvement on IE-related mortality, notwithstanding the less favourable patients' baseline characteristics.
- © 2010 by American Heart Association, Inc.