According to an investigation in the November 23/30 issue of JAMA, approximately two-thirds of individuals with heart failure and infective endocarditis receive valvular surgery, which is associated with a considerable reduction in the risk of death in hospital and at one year following surgery. Infective endocarditis is an infection of the heart lining which may involve the heart valves.

Background information in the report states:

"Infective endocarditis is associated with substantial morbidity and mortality. Several published studies have reported in-hospital mortality of 15 percent to 20 percent and 1-year mortality of 40 percent. In the United States alone, approximately 15,000 new cases of infective endocarditis are diagnosed each year. A variety of complications contribute to the high rates of morbidity and mortality in infective endocarditis, particularly heart failure (HF), which occurs in approximately 40 percent of patients."

The risk of death from infective endocarditis complicated by heart failure can be reduced with valvular surgery, according to prior studies. The procedure is strongly recommended by the American College of Cardiology/American Heart Association and European Society of Cardiology.

Todd Kiefer, M.D., Ph.D., of Duke University Medical Center, Durham, N.C., and his team carried out an investigation in order to analyze the microbiological, clinical, and echocardiography variables connected with heart failure development in individuals with infective endocarditis.

In addition the team analyzed variables linked to in-hospital and 1-year death rates, including the use and effects of surgery on outcome. The study, which took place at 61 centers in 28 countries, included 4,166 individuals with native- or prosthetic-valve infective endocarditis between June 2000 and December 2006.

1, 359 (33.4%) of the 4,075 participants with infective endocarditis and known HF status factor had heart failure, while 66.7% (906 patients) were categorized as having New York Heart Association class III of IV symptom status (greater degree of limitations/symptoms with physical activity). 839 (61.7%) of patients with heart failure underwent valvular surgery during the index hospitalization. The team discovered that for the entire heart failure cohort, in-hospital mortality was 29.7%. Lower mortality was observed in individuals who underwent valvular surgery (20.6%) compared to patients who only received medical treatment (44.8%). Furthermore, the researchers found that one-year mortality was 29.1% in individuals who underwent the procedure compared to 58.4% in patients with medical therapy alone.

Independent factors linked to one-year mortality include:
  • Diabetes
  • Older age
  • Health care-associated infection
  • Mellitus
  • Stroke
  • Paravalvular complications
  • Causative microorganism (Staphylococcus aureus or fungi)
  • Severe HF (New York Heart Association class III or IV)
Lower mortality was connected with valvular surgery during the initial hospitalization.

The researchers highlight that almost one-third of individuals with heart failure and high surgical propensity did not have surgery emphasizes the need for multi-disciplinary, guideline-based management of infective endocarditis.

They explain:

"Improved recognition of HF and institutional systems to promote appropriate treatment of infective endocarditis may enhance the rate of surgery for this indication.

Additional studies are need to better risk-stratify patients with infective endocarditis and HF and optimize the use of surgery for this serious condition."

Written by Grace Rattue