Related Experiment Video
Updated: Mar 25, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Infective Endocarditis Hospitalizations Before and After the 2007 American Heart Association Prophylaxis Guidelines
Andrew S Mackie1, Wei Liu2, Anamaria Savu2
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
Insights
The American Heart Association
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The American Heart Association (AHA) revised infective endocarditis (IE) prophylaxis guidelines in 2007.
- Population-based data assessing the impact of these revised guidelines were previously unavailable.
- Understanding trends in IE hospitalizations is crucial for public health strategies.
Purpose of the Study:
- To evaluate the impact of the 2007 American Heart Association guidelines on infective endocarditis (IE) hospitalization rates in Canada.
- To analyze trends in IE hospitalizations before and after the guideline publication.
- To identify changes in causative organisms and risk factors for IE.
Main Methods:
- Utilized the Canadian Institute for Health Information Discharge Abstract Database for IE hospitalizations (April 2002–March 2013).
- Calculated hospitalization rates using age-specific population data from Statistics Canada.
- Employed interrupted time series analysis to assess changes in hospitalization trends post-guideline publication.
Main Results:
- Infective endocarditis hospitalization rates increased both before and after the 2007 AHA guidelines.
- No significant change in the slope of IE hospitalization rates was observed following the 2007 guideline release.
- Staphylococcus aureus was the most common pathogen; pacemaker/defibrillator presence emerged as an increasing risk factor.
Conclusions:
- The 2007 American Heart Association guidelines did not significantly alter the incidence of infective endocarditis hospitalizations in Canada.
- IE hospitalization rates showed a continuous increasing trend, unaffected by the revised prophylaxis recommendations.
- Further research into evolving risk factors and effective prevention strategies for IE is warranted.
Background:
In 2007, the American Heart Association (AHA) published revised guidelines for infective endocarditis (IE) prophylaxis. Population-based data with respect to the potential impact of these revised guidelines are lacking.
Methods:
The Canadian Institute for Health Information Discharge Abstract Database was used to identify all hospitalizations between April 2002 and March 2013 having IE as a primary diagnosis. Hospitalization rates were determined using age-specific population data from Statistics Canada. Interrupted time series analysis was used to evaluate changes in the slope of hospitalization rates after the AHA guidelines were published.
Results:
There were 9431 hospitalizations during the study period among 8055 patients (63% male patients). Time trend analysis showed an increase of 0.05 IE hospitalizations per 10 million population per month (95% confidence interval, 0.005-0.09; P = 0.029) from April 2002-March 2007 and an increase of 0.07 IE hospitalizations per 10 million population per month from April 2007-March 2013 (interaction P = 0.5213). Change-point analysis showed that a change in the slope occurred in April 2011, 4 years after publication of the revised AHA guidelines. Staphylococcus aureus was the most commonly reported organism (29.4%). Streptococcal infections decreased over time, beginning before the 2007 guidelines (P < 0.0001). The presence of a pacemaker or defibrillator was an increasingly prevalent risk factor over time (4% increase per year; P = 0.0178).
Conclusions:
The rate of IE hospitalizations increased in Canada before and after the publication of the 2007 AHA guidelines, with no significant change in slope after 2007. These guidelines had no impact on the incidence of IE hospitalizations.
Related Concept Videos
01:25Endocarditis I: Introduction
01:18Endocarditis III: Medical Management
01:29Endocarditis IV: Nursing Management
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:21Rheumatic Heart Disease III: Medical Management