Abstract 12447: Impact of 2007 American Heart Association Infective Endocarditis Prevention Guidelines on Endocarditis Related Pediatric Hospital Admissions: A U.S. Population-Based Study
Purpose: The 2007 American Heart Association (AHA) guidelines for the prevention of infective endocarditis (IE) called for a major change in indications for antibiotic prophylaxis. Purpose of this study was to evaluate the national trends and mortality in IE; its associations with congenital heart disease (CHD); and the impact of 2007 AHA prevention guidelines.
Methods: This retrospective study examined inpatient admissions (age <20 yrs) for IE using nationally representative Kids’ inpatient database (KID), for the years 2006 and 2009. Complex sample analysis was performed to obtain weighted estimates of incidence and mortality rates on CHD associated with IE admissions. Categorized variables related to hospital and patient demographics were also studied.
Results: Out of 7.56 and 7.37 million total admissions in the years 2006 and 2009, there were 1,515 (95% CI 1,329-1,701) and 1,323 (95% CI 1,157-1,489) hospital admissions for IE, respectively (P = 0.072). While the incidence of IE-related admissions associated with isolated ASD increased significantly in year 2009 (P < 0.001), there was a decline (P = 0.020) in those admissions associated with isolated VSD. There was no significant change seen in the distribution of other CHD groups.
There was no significant change in overall mortality rate associated with IE-related admissions between the years 2006 and 2009 (P = 0.440). Non-white race and CHD were significant factors associated with mortality in IE-related admissions. Among CHD associated with IE admissions, isolated PDA, LVOTO, RVOTO were significantly associated with increased mortality on univariate analysis.
Conclusion: The 2007 AHA endocarditis prevention guidelines did not have a significant impact on the overall rate of hospital admissions for IE in calendar year 2009 compared to 2006. However, there was a significant decline in IE admissions with associated diagnosis of isolated VSD. The increase noted in the small number of IE admissions with associated isolated ASD is likely a confounding bias. Non-white race and CHD, particularly isolated PDA, LVOTO and RVOTO lesions were significantly associated with increased mortality in IE admissions on univariate analysis.
Author Disclosures: A.R. Doshi: None. C. Srinivasan: None. H.H. Desai: None. H.P. Bhatt: None. M. Moulik: None.
- © 2014 by American Heart Association, Inc.