Abstract 18908: Trends in Endocarditis Hospitalizations: Impact of the 2007 American Heart Association Guidelines on Adults With Congenital Heart Disease
Introduction: In 2007, the American Heart Association (AHA) modified the recommendations for infective endocarditis (IE) antibiotic prophylaxis for all but the individuals at the highest risk of acquiring IE. The impact of these guidelines remains unclear, particularly for adults with congenital heart disease (CHD). Our objective was to evaluate the trend in IE hospitalization and mortality before and after implementation of the revised AHA guidelines.
Hypothesis: We hypothesized no change in the overall trend in IE hospitalization and mortality, including those adults with CHD, in the period after adoption of the 2007 AHA endocarditis guidelines.
Methods: We utilized the Texas Hospital Inpatient Discharge Public Use Data File to identify all patients hospitalized between 2001and 2011 with IE in Texas. We evaluated the trend over time of IE admission and the percentage of those with CHD. We also assessed mortality and need for surgery during the hospital admission.
Results: We identified 29, 537 IE cases. There was a steady increase in IE hospitalizations over the 10-year period from 1515 cases in 2001 to 3009 in 2011, comprising an increasing proportion of total IE admissions (0.13% in 2001 to 0.17% in 2011, p for trend <0.0001).
Of the patients admitted with IE, 3.3% had CHD. While both IE and percentage with CHD increased overtime, neither had a significant change after the 2007 AHA guidelines (Figure 1). Overall CHD mortality decreased from 14.2% in 2001 to 13.7% in 2011 (p=0.09). Overall mortality for the 10-year period was 14.2% without CHD and 9.1% with CHD (p<0.0001). Adults were three times more likely to undergo surgery if they had CHD (25.4% vs 8.1%; p<0.0001).
Conclusions: We found no evidence that the 2007 AHA antibiotic prophylaxis guidelines was associated with a significant change in IE admissions across Texas hospitals, even when accounting for adults with CHD. Overall IE admissions, including those with CHD have continued to increase steadily.
- © 2013 by American Heart Association, Inc.