Infective endocarditis treated in a secondary hospital: epidemiological, clinical, microbiological characteristics and prognosis, with special reference to patients transferred to a third level hospital

Introduction. To analyse the clinical and epidemiological characteristics and mortality-related factors of patients admitted to a secondary hospital with Infective Endocarditis (IE). Methods. Observational study of a cohort of patients who have been diagnosed with IE in a secondary hospital and evaluated in accordance with a pre-established protocol. Results. A total of 101 cases were evaluated (years 2000-2017), with an average age of 64 years and a male-to-female ratio of 2:1. 76% of the cases had an age-adjusted Charlson comorbidity index of >6, with 21% having had a dental procedure and 36% with a history of heart valve disease. The most common microorganism was methicillin-susceptible S. aureus (36%), with bacterial focus of unknown origin in 54%. The diagnostic delay time was 12 days in patients who were transferred, compared to 8 days in patients who were not transferred (p=0.07); the median surgery indication delay time was 5 days (IQR 13.5). The in-hospital mortality rate was 34.6% and the prognostic factors independently associated with mortality were: cerebrovascular events (OR 98.7%, 95% CI, 70.9–164.4); heart failure (OR 27.3, 95% CI, 10.2–149.1); and unsuitable antibiotic treatment (OR 7.2, 95% CI, 1.5–10.5). The mortality rate of the patients who were transferred and who therefore underwent surgery was 20% (5/25). Conclusions. The onset of cerebrovascular events, heart failure and unsuitable antibiotic treatment are independently and significantly associated with in-hospital mortality. The mortality rate was higher than the published average (35%); the diagnostic delay was greater in patients for whom surgery was indicated.

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Trends in hospitalization and in-hospital mortality of patients with heart failure in Spain. A population-based study (2003–2015)

European Heart Journal ◽

10.1093/ehjci/ehaa946.1187 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.L Bonilla Palomas ◽

M.P Anguita-Sanchez ◽

F.J Elola ◽

J.L Bernal ◽

C Fernandez-Perez ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Hospital Mortality ◽

National Health System ◽

Admission Rate ◽

Population Data ◽

Principal Diagnosis ◽

Data Set ◽

Discharge Rates ◽

Mortality Ratio

Abstract Background Heart failure (HF) is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. Purpose To investigate trends in HF hospitalization and in-hospital mortality rates. Methods We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2003–2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We analyzed trends in hospital discharge rates for HF (discharge rates were weighted by age and gender) an in-hospital mortality. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality (which individually considers the performance of the hospital where the patient is attended) and expected mortality (which considers a standard performance according to the average of all hospitals) multiplied by the crude rate of mortality. RSMR was calculated using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Temporal trend during the observed period was modelled using Poisson regression analysis with year as the only independent variable. In this model, the incidence rate ratio (IRR) and their 95% confidence intervals (95% CI) was calculated. Results A total of 1 254 830 episodes of HF were selected. Throughout 2003–2015 the number of hospital discharges with principal diagnosis of HF increased by 61% (IRR: 1.04; CI: 1.03–1.04; p<0.001), meanwhile the crude mortality rate and the mean length of stay (LOS) diminished significantly (IRR: 0.99; CI: 0.98–1; and IRR: 1.04; CI: 0.99–0.99; p<0.001, for both). Discharge rates weighted by age and sex showed a statistically significant increase during the period (IRR: 1.03; CI: 1.03–1.03; p<0.001); however, whereas discharge rates increased significantly in older groups of age (≥75 years old) (IRR: 1–1.02; p<0.001) they diminished in younger groups of age (45–74 years old) (IRR: 0.99; p<0.001 and there was not a significant trend in the discharge rates for the group of 35–44 years old (Figure). The risk-standardized in-hospital mortality ratio did not significantly change throughout 2003–2015 (IRR: 0.997; CI: 0.992–1; p=0.32), however the risk-standardized LOS ratio diminished from 1.07 in 2003 to 0.97 in 2015 (IRR: 0.98: IC: 0.98–0.99; p<0.001). Conclusions From 2003 to 2015, HF admission rate increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population over 75. The crude in-hospital mortality rate diminished significantly for the same period, but the risk-standardized in-hospital mortality ratio did not significantly change. Figure 1 Funding Acknowledgement Type of funding source: None

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Abstract P75: Cerebrovascular Events and Outcomes in Hospitalized Patients With Covid-19: The Society of Vascular and Interventional Neurology Multinational Registry

Stroke ◽

10.1161/str.52.suppl_1.p75 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

James E Siegler ◽

Pere Portela ◽

Juan F Arenillas ◽

Alba Chavarria-Miranda ◽

Ana Guillen ◽

...

Keyword(s):

Ischemic Stroke ◽

Mortality Rate ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Cryptogenic Stroke ◽

Significant Risk ◽

Stroke Severity ◽

Cerebrovascular Event ◽

Cerebrovascular Events ◽

Observational Cohort

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in 4 countries (2/1/2020 - 06/16/2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) of whom were female and 96/172 (55.8%) were between the ages 60-79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130 - 280/100,000) and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p<0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p<0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p=0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98 p=0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19 associated cerebrovascular complications, therefore aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

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Implementation of a specialist pneumonia intervention nurse service significantly lowers mortality for community acquired pneumonia

10.1101/19007336 ◽

2019 ◽

Author(s):

Robert C. Free ◽

Matthew Richardson ◽

Camilla Pillay ◽

Julie Skeemer ◽

Kayleigh Hawkes ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Antibiotic Treatment ◽

Clinical Education ◽

Guideline Adherence ◽

Low Cost ◽

Community Acquired Pneumonia ◽

Bottom Line ◽

Specialist Nurse ◽

Guidelines Adherence

AbstractObjectivesEvaluate clinical outcomes associated with implementing a specialist pneumonia intervention nursing (SPIN) service, to improve adherence with BTS guidelines for hospitalised community acquired pneumonia (CAP).DesignRetrospective cohort study, comparing periods before (2011-13) and after (2014-16) SPIN service implementation.SettingSingle NHS trust across two hospital sites in Leicester City, EnglandParticipants13,496 adult (aged ≥16) admissions to hospital with a primary diagnosis of CAPInterventionsThe SPIN service was set up in 2013/2014 to provide clinical review of new CAP admissions; assurance of guidelines adherence; delivery of CAP clinical education and clinical follow up after discharge.Main outcome measuresThe primary outcomes were proportions of CAP cases receiving antibiotic treatment within 4 hours of admission and change in crude in-hospital mortality rate. Secondary outcomes were adjusted mortality rate and length of stay (LOS).ResultsThe SPIN service reviewed 38% of CAP admissions in 2014-16. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 [0.70-0.85], p<0.0001) and in-hospital mortality (OR=0.66 [0.60-0.73], p<0.0001) after service implementation, with a review by the service having the largest independent 30-day mortality benefit (HR=0.60 [0.53-0.67], p<0.0001). There was no change in LOS (median 6 days).ConclusionsImplementation of a SPIN service improves adherence with BTS guidelines and achieves significant reductions in CAP associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.Key MessagesWhat is the key question?Does a specialist nurse-led intervention affect BTS guideline adherence and mortality for patients admitted to hospital with community acquired pneumonia (CAP)?What is the bottom line?Implementing specialist nurse teams for CAP delivers improved guideline adherence and survival for patients admitted with the condition.Why read on?This study shows a low-cost specialist nursing service focussed on CAP is associated with a significant improvement in BTS guidelines adherence and patient survival.

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Abstract 17132: Atrial Fibrillation Ablation in Heart Failure: Temporal Trends and Outcomes in Hospitalized Patients

Circulation ◽

10.1161/circ.138.suppl_1.17132 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Manyoo Agarwal ◽

Brijesh Patel ◽

Lohit Garg ◽

Mahek Shah ◽

Rami Khouzam ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Mortality Rate ◽

Hospital Mortality ◽

Temporal Trends ◽

Complication Rates ◽

Af Ablation ◽

Southern Us ◽

Comorbidity Burden

Introduction: Recent studies have shown catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) to have better outcomes over medical therapy. While AF ablation is predominantly an outpatient procedure, some patients may require longer hospitalization. Limited literature exists describing the trends of hospitalizations for HF patients undergoing AF ablation. Methods: Using ICD-9 (diagnosis and procedure codes) in nationwide inpatient sample database 2003 to 2014, we identified all HF adults who were admitted with a principal diagnosis code of AF (427.31) (n= 4,670,400) (AF-HF). Among these, we identified those with a principal procedure code of catheter ablation (37.34) and studied the temporal trends of clinical characteristics and outcomes (in-hospital mortality and complications) for this cohort (Table). Results: The overall number of AF-HF patients undergoing AF ablation was 62,653; with an increase from 1,928 in 2003 to 6,860 in 2014 (p trend<0.001). As shown in Table, over this 12-year period; mean age and proportion of females decreased, while there was an increase in blacks, clinical comorbidity burden, admissions to teaching hospitals and southern US region (all p trend<0.001). The overall procedure related complications (vascular, cardiac, respiratory, neurologic) increased, the in-hospital mortality rate decreased from 1.7% to 0.5% (all p trend<0.001). Conclusions: During 2003-2014, the annual incidence of AF ablation related hospitalizations in HF patients increased significantly. Despite increase in clinical comorbidities burden and procedural complication rates, the mortality rate declined.

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Infective endocarditis

Oxford Handbook of Cardiac Nursing ◽

10.1093/med/9780198832447.003.0005 ◽

2020 ◽

pp. 115-128

Keyword(s):

At Risk ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

High Mortality ◽

Clinical Management ◽

Valve Disease ◽

Educational Issues ◽

The Uk

Infective endocarditis (IE) is a condition that most commonly occurs in patients with pre-existing valve disease. It affects one in 30 000 people in the UK and is associated with a high mortality rate (15–30% in hospital mortality). Nurses working in the cardiac arena should be aware of those patients who are at risk of developing IE and its clinical management. This chapter covers the aetiology, diagnosis, complications, treatment, nursing considerations, and specific educational issues that are relevant to the overall management and prevention of IE.

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Infective endocarditis at a tertiary care hospital in South Korea

Heart ◽

10.1136/heartjnl-2020-317265 ◽

2020 ◽

Vol 107 (2) ◽

pp. 135-141 ◽

Cited By ~ 4

Author(s):

Jung Ho Kim ◽

Hi Jae Lee ◽

Nam Su Ku ◽

Seung Hyun Lee ◽

Sak Lee ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Infective Endocarditis ◽

Mortality Rate ◽

South Korea ◽

Hospital Mortality ◽

Care Hospital ◽

Multivariable Logistic Regression ◽

Long Term Prognosis

ObjectiveThe treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.MethodsA 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.ResultsWe included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).ConclusionsThe incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.

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146. Infective Endocarditis in South Korea: a 12-year Single-Center Experience of 419 Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.221 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S100-S101

Author(s):

Jung Ho Kim ◽

Hi Jae Lee ◽

Woon Ji Lee ◽

Hye Seong ◽

Jin young Ahn ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Logistic Regression ◽

Regression Analysis ◽

Infective Endocarditis ◽

Mortality Rate ◽

South Korea ◽

Hospital Mortality ◽

Incidence Rate ◽

Logistic Regression Analysis

Abstract Background Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea. Methods We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term. Results There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001) Conclusion Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis. Disclosures All authors: No reported disclosures.

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Candida Infective Endocarditis: an Observational Cohort Study with a Focus on Therapy

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04867-14 ◽

2015 ◽

Vol 59 (4) ◽

pp. 2365-2373 ◽

Cited By ~ 28

Author(s):

Christopher J. Arnold ◽

Melissa Johnson ◽

Arnold S. Bayer ◽

Suzanne Bradley ◽

Efthymia Giannitsioti ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Infective Endocarditis ◽

Mortality Rate ◽

Amphotericin B ◽

Prospective Cohort Study ◽

Antifungal Therapy ◽

Subgroup Analysis ◽

Prospective Cohort ◽

Content Type

ABSTRACTCandidainfective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens forCandidainfective endocarditis. This prospective cohort study was based on 70 cases ofCandidainfective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion,Candidainfective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.

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Recovery from hyponatremia in acute phase is associated with better in-hospital mortality rate in acute heart failure syndrome

Journal of Cardiology ◽

10.1016/j.jjcc.2015.12.004 ◽

2016 ◽

Vol 67 (5) ◽

pp. 406-411 ◽

Cited By ~ 12

Author(s):

Kenji Yoshioka ◽

Yuya Matsue ◽

Nobuyuki Kagiyama ◽

Kazuki Yoshida ◽

Teruyoshi Kume ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Acute Phase ◽

Acute Heart Failure Syndrome

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Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

10.21203/rs.2.19349/v1 ◽

2019 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyis Shi ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

Tertiary Hospital ◽

The Past ◽

Increasing Trend ◽

One Year

Abstract Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and streptococci (44.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.5, 95% CI 5.5-148.1) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There was no significant change in the overall incidence of IE, the clinical features of IE have changed slightly during the past ten years. Streptococci IE was still the predominant. IE patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

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