Abstract 17831: Quantifying Infective Endocarditis Risk in Patients With Predisposing Heart Conditions: A Large Population-Based Cohort Study
Introduction: Identifying individuals at risk of infective endocarditis (IE) is important for targeting prevention and raising the index of suspicion for early diagnosis. There is, however, scant comparative data on the risk of IE or a poor IE outcome (IE associated mortality), with different cardiac conditions.
Methods: English in-patient hospital admissions from January 2000 - March 2008 were analyzed for diagnoses or procedures associated with an increased risk of IE and followed for 5 years to quantify subsequent IE admissions. Using logistic regression, that also controlled for age and gender, the 5-year odds of developing IE or of mortality during the IE admission were calculated for each condition.
Results: IE incidence was 58/million/year in the reference group (cardiology admissions with no predisposing cardiac risk factors). Overall, the risk of developing IE (OR 1.56) or IE mortality (OR 1.2) was higher in men. Previous IE was associated with the greatest risk of IE recurrence (OR 104) or IE mortality (OR 124), even after excluding IE recurrence within 6 months. Patients with prosthetic valves or valves repaired with prosthetic material had the next highest risk of IE (OR 48 & 38 respectively) or IE related mortality (OR 51 & 42). The risks in all 3 ‘moderate-risk categories’, however, were higher than for cyanotic congenital heart conditions (CHC) or CHC repaired with prosthetic material, that are both designated high-risk in the AHA categorization. In the ‘other risk categories’, annuloplasties had a high-risk of IE (OR 32) and IE mortality (OR 27) while implanted pacemakers/cardioverters had a lower but still significant risk of IE (OR 9) and IE mortality (OR 10).
Conclusion: AHA guidelines currently restrict antibiotic prophylaxis (AP) to those at high-risk. Our data highlight the very high-risk associated with previous IE but suggests there may be a need to re-evaluate patients considered at high vs. moderate risk of IE and who may benefit most, therefore, from AP.
Author Disclosures: M.J. Dayer: None. S. Jones: None. B. Prendergast: None. L.M. Baddour: None. J. Chambers: None. P.B. Lockhart: None. M.H. Thornhill: None.
- © 2016 by American Heart Association, Inc.