Endocarditis prophylaxis in a primary care clinic

Primary care physicians often make decisions about the use of endocarditis prophylaxis (EP). Compliance with American Heart Association (AHA) recommendations has been found to be poor in hospitalized patients and in a dental school clinic. The purpose of this study was to examine the use of endocarditis prophylaxis in a primary care clinic.

The problem list of all adult patients seen in a primary care clinic in 1989 was reviewed for diagnoses that might require EP. Eighty-four charts were identified and reviewed.

Sixty-five percent of the study patients had documentation in their charts about the need for EP. Mitral valve prolapse was the most frequent diagnosis. The physicians recommended EP for most patients with mitral valve prolapse regardless of whether there was documented mitral insufficiency. Endocarditis prophylaxis was most commonly prescribed for dental procedures. Six patients received prophylaxis for procedures for which the AHA does not recommend prophylaxis. Only 19% of the antibiotic regimens prescribed were entirely consistent with the AHA 1984 guidelines. The most common deviation from the AHA guidelines was continuing oral antibiotics too long.

Compliance with the AHA 1984 recommendations, although better than reported in other settings, was less than optimal in this primary care clinic. Family physicians should consider whether EP is indicated in any patient with cardiac disease. If prophylaxis is indicated, then such a recommendation should be clearly documented in the chart. Family physicians need to be familiar with the 1990 AHA recommendations.