Related Experiment Video
Updated: Sep 5, 2025
An In Vitro Model of a Parallel-Plate Perfusion System to Study Bacterial Adherence to Graft Tissues
Published on: January 7, 2019
Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis
Ajay Kumar Mishra1, Benson M Abraham2, Kamal K Sahu3
1From the Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester.
Insights
Infective endocarditis patients leaving against medical advice (AMA) are often younger females with higher comorbidities like drug use and prior IE. These patients experience increased morbidity, including embolic events and recurrent admissions.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Leaving against medical advice (AMA) is a significant issue in hospital medicine globally.
- Infective endocarditis (IE) poses unique challenges when patients leave treatment prematurely.
Purpose of the Study:
- To investigate the demographic, clinical, and laboratory profiles of IE patients who leave AMA.
- To compare risk factors and outcomes of IE patients leaving AMA versus those completing treatment.
Main Methods:
- Retrospective study analyzing 111 patients diagnosed with IE over 36 months.
- Detailed comparison of 32 patients leaving AMA with those who completed therapy.
Main Results:
- Patients leaving AMA were younger (mean age 39), predominantly female (66%), and had higher rates of injection drug use (68.1%), prior IE (83.3%), and chronic hepatitis C (72.4%).
- Higher psychiatric comorbidities (63%), history of leaving AMA (70.5%), and substance abuse were noted in the AMA group.
- Patients leaving AMA experienced significantly higher morbidity, including distal emboli, recurrent admissions, and recurrent bacteremia.
Conclusions:
- IE patients leaving AMA are typically younger females with substantial comorbidities including substance abuse and psychiatric issues.
- Leaving AMA is associated with increased morbidity, such as embolic events and recurrent hospitalizations.
- Addressing socioeconomic factors and comorbidities is crucial for improving treatment adherence in IE patients.
Introduction:
Patients leaving against medical advice (AMA) are commonly encountered in hospital medicine. The problem is prevalent worldwide and across all fields of medicine. A retrospective study of 47,583 patients reported a 3.3% AMA rate in 2015.
Objectives:
In this retrospective study, we aimed (1) to study the demographic, clinical, and laboratory parameters of infective endocarditis (IE) patients leaving AMA. We also compared (2) the various risk factors and outcomes of these patients with IE patients who completed treatment.
Results:
A total of 111 patients diagnosed with IE were recruited for 36 months. Of the 74 patients with available details, 32 patients (29%) left AMA during their treatment. The mean age of patients leaving AMA was 39, and among those who left AMA, 66% were females. As compared with patients completing therapy, patients leaving AMA tend to have higher comorbidities, including injection drug use (68.1% versus 31.9%), prior IE (83.3% versus 16.7%), and chronic hepatitis C (72.4% versus 27.8%). Rates of consumption of substances of abuse were higher among those who left AMA. Patients leaving AMA also had higher psychiatric comorbidities (63% versus 37.5%), history of leaving AMA (70.5% versus 29.5%), and consumption of more than 2 substances of abuse. Morbidity was higher in patients leaving AMA. There was a statistically significant association between the development of distal embolus ( P < 0.001), the need for recurrent admissions ( P = 0.002), recurrent bacteremia ( P < 0.001), developing new embolus ( P < 0.001), and overall morbidity ( P = 0.002) among IE patients leaving AMA.
Conclusions:
Infective endocarditis patients leaving AMA tend to be younger females. These patients have prior comorbidities of injection drug use, prior IE, multiple psychiatric comorbidities, drug use, and multiple socioeconomic issues. Patients leaving AMA tend to develop further non-Central nervous system embolic events, recurrent bacteremia, and require frequent admissions. Morbidity in these patients was higher.
Related Concept Videos
01:18Endocarditis III: Medical Management
01:25Endocarditis I: Introduction
01:29Endocarditis IV: Nursing Management
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:14Myocarditis III: Medical Management
01:26Mitral Stenosis III: Medical Management