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Incidence of infective endocarditis in patients considered at moderate risk

Lauge Østergaard1, Nana Valeur2, Andrew Wang3

  • 1Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark.

European Heart Journal
|October 23, 2018
PubMed
Abstract

Insights

Patients with heart valve disorders, cardiac implantable electronic devices (CIED), or hypertrophic cardiomyopathy (HCM) face increased infective endocarditis (IE) risk. These moderate-risk groups have lower IE risk than high-risk patients, informing prophylactic strategies.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Epidemiology

Background:

  • Stratifying patients for infective endocarditis (IE) prophylaxis is crucial.
  • Moderate-risk patient groups, such as those with specific cardiac conditions or devices, are often overlooked.
  • Understanding IE risk in these populations is essential for effective preventative strategies.

Purpose of the Study:

  • To assess the risk of infective endocarditis (IE) in patients with moderate-risk cardiac conditions.
  • To compare IE risk in patients with aortic/mitral valve disorders, cardiac implantable electronic devices (CIEDs), or hypertrophic cardiomyopathy (HCM) against background and high-risk populations.
  • To inform IE prophylactic strategies by better defining risk in moderate-risk groups.

Main Methods:

  • Utilized Danish nationwide registries to identify patients with valve disorders, CIEDs, or HCM.
  • Employed risk-set matching to compare these groups with the general population.
  • Used Cox proportional hazard analysis to compare IE risk between moderate-risk groups and a high-risk population (prosthetic heart valve).

Main Results:

  • Identified 83,453 patients with valve disorders, 50,828 with CIEDs, and 3,620 with HCM.
  • Found a 10-year cumulative IE risk of 0.9% (valve disorder), 1.3% (CIED), and 0.5% (HCM).
  • Compared to the background population, valve disorders (HR=8.75), CIEDs (HR=6.63), and HCM (HR=6.57) showed significantly higher IE risk. All groups had lower risk than high-risk patients (HRs 0.13-0.28).

Conclusions:

  • Patients with heart valve disorders, CIEDs, and HCM represent moderate-risk groups for infective endocarditis.
  • These moderate-risk groups have a substantially higher IE risk than the general population.
  • Their IE risk is significantly lower than that of high-risk individuals, such as those with prosthetic heart valves.
Keywords:
Endocarditis prophylaxissIncidenceInfective endocarditisModerate-risk patients

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