Infective Endocarditis in the Elderly: Challenges and Strategies

Area of Science:

• Cardiology
• Geriatrics
• Infectious Diseases

Background:

• Infective endocarditis (IE) management in elderly patients lacks specific guideline focus despite rising incidence and mortality.
• Elderly patients present with significant comorbidity, heterogeneity, and increased risk of colorectal cancer, impacting IE outcomes.
• Diagnosis is challenging due to atypical IE presentations and reduced sensitivity of imaging in older adults.

Purpose of the Study:

• To highlight the unique challenges and considerations for managing infective endocarditis in the elderly population.
• To emphasize the need for adapted diagnostic and therapeutic strategies for older patients with IE.

Main Methods:

• Review of current literature and guidelines concerning infective endocarditis in elderly patients.
• Analysis of factors influencing diagnosis, treatment, and outcomes in older individuals with IE.
• Emphasis on geriatric assessment, frailty, and multidisciplinary team approaches.

Main Results:

• Elderly patients exhibit a higher incidence of enterococcal IE and increased risk of concurrent cancers, particularly colorectal cancer.
• Atypical IE presentations and lower imaging performance complicate diagnosis in older adults.
• Antibiotic therapy must balance efficacy with reduced adverse effects and drug interactions, with surgery being less common due to high risk.

Conclusions:

• A comprehensive geriatric assessment, including frailty evaluation, is essential for elderly IE patients.
• Multidisciplinary team management is critical for optimizing IE care and outcomes in the aging population.
• Tailored antibiotic strategies and careful consideration of surgical risks are paramount for elderly patients with IE.