Infective endocarditis: clinical features in young and elderly patients

Area of Science:

• Cardiology
• Infectious Diseases
• Geriatrics

Background:

• Infective endocarditis (IE) affects an increasing elderly population.
• Understanding IE in older adults is crucial due to potential differences in presentation and outcomes.

Purpose of the Study:

• To compare the clinical manifestations, causative agents, sources of infection, and outcomes of IE in elderly patients versus younger age groups.
• To identify factors contributing to diagnostic delays and higher mortality in elderly IE patients.

Main Methods:

• Retrospective review of 53 IE episodes in patients over 60.
• Comparison with 55 episodes in patients under 40 and 46 episodes in patients aged 40-60.
• Analysis of causative organisms, infection sources, diagnostic accuracy, and mortality rates.

Main Results:

• Enterococci, Streptococcus bovis, and coagulase-negative staphylococci were more prevalent in the elderly.
• Invasive vascular procedures and nosocomial acquisition were common sources in older patients.
• Elderly patients exhibited fewer symptoms, diminished fever, higher diagnostic errors (68%), delayed therapy, and significantly higher mortality (45.3%) compared to younger groups.

Conclusions:

• Infective endocarditis in the elderly is frequently nosocomially acquired and presents with subtle symptoms, leading to diagnostic challenges.
• Older patients with IE experience significantly higher mortality rates than younger individuals.
• Targeted diagnostic and therapeutic strategies are needed for elderly patients with infective endocarditis.