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Infective endocarditis: determinants of long term outcome
  1. R O M Netzer1,
  2. S C Altwegg1,
  3. E Zollinger1,
  4. M Täuber2,
  5. T Carrel1,
  6. C Seiler1
  1. 1Swiss Cardiovascular Centre Bern, University Hospital, Bern, Switzerland
  2. 2Institute for Infectious Diseases, University Hospital, Bern, Switzerland
  1. Correspondence to:
    Professor Christian Seiler, Swiss Cardiovascular Centre Bern, University Hospital, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland;
    christian.seiler@cardio{at}insel.ch

Abstract

Objective: To evaluate predictors of long term prognosis in infective endocarditis.

Design: Retrospective cohort study.

Setting: Tertiary care centre.

Patients: 212 consecutive patients with infective endocarditis between 1980 and 1995

Main outcome measures: Overall and cardiac mortality; event-free survival; and the following events: recurrence, need for late valve surgery, bleeding and embolic complications, cerebral dysfunction, congestive heart failure.

Results: During a mean follow up period of 89 months (range 1–244 months), 56% of patients died. In 180 hospital survivors, overall and cardiac mortality amounted to 45% and 24%, respectively. By multivariate analysis, early surgical treatment, infection by streptococci, age < 55 years, absence of congestive heart failure, and > 6 symptoms or signs of endocarditis during active infection were predictive of improved overall long term survival. Independent determinants of event-free survival were infection by streptococci and age < 55 years. Event-free survival was 17% at the end of follow up both in medically–surgically treated patients and in medically treated patients.

Conclusions: Long term survival following infective endocarditis is 50% after 10 years and is predicted by early surgical treatment, age < 55 years, lack of congestive heart failure, and the initial presence of more symptoms of endocarditis.

  • infective endocarditis
  • late cardiac surgery
  • long term follow up
  • outcome

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