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Impact of the COVID-19 Pandemic on Infective Endocarditis Management and Outcomes: Analysis of a National Clinical

Alexandra Novelli1, Arnar B Ingason2, Caroline Jirka2

  • 1Department of Medicine, Duke University School of Medicine, Durham, North Carolina.

The American Journal of Cardiology
|November 3, 2023
PubMed

Insights

The COVID-19 pandemic worsened outcomes for general infective endocarditis (IE) admissions but improved mortality for valve surgery patients. This study analyzed national IE trends before and after the pandemic declaration, revealing significant shifts in patient complexity and survival rates.

Area of Science:

  • Cardiology and Infectious Diseases
  • Healthcare Management and Outcomes Research
  • Epidemiology of Cardiovascular Infections

Background:

  • The COVID-19 pandemic significantly disrupted healthcare delivery globally.
  • The specific impact of the pandemic on infective endocarditis (IE) management and outcomes, particularly valve surgery, remained unclear.
  • Understanding these shifts is crucial for optimizing patient care during public health crises.

Purpose of the Study:

  • To compare national trends in infective endocarditis (IE) admissions, patient demographics, and clinical outcomes before and after the onset of the COVID-19 pandemic.
  • To evaluate the impact of the pandemic on patients undergoing valve surgery for IE.
  • To identify changes in IE patient complexity and associated mortality rates.

Main Methods:

  • Utilized a national sample of IE admissions from the Vizient Clinical Database (2016-2022).
  • Defined pre-COVID-19 and post-COVID-19 periods based on the pandemic declaration in Q2 2020.
  • Employed 2-sample t tests, chi-square tests, and propensity score-matched analyses to compare baseline characteristics and outcomes between the two periods for all IE admissions and those involving valve surgery.

Main Results:

  • Post-pandemic IE admissions showed increased in-hospital mortality (11.4% vs 12.4%), stroke (4.9% vs 6.0%), myocardial infarction (1.3% vs 1.4%), and aspiration pneumonia (1.8% vs 2.4%) in the matched analysis.
  • Patients undergoing valve surgery during the pandemic experienced decreased in-hospital mortality (7.7% vs 6.7%) and shorter intensive care unit stays (8.5 vs 8.0 days) in the matched analysis.
  • Overall IE admissions decreased significantly post-pandemic (82,867 to 45,672) as did valve surgery admissions (11,337 to 6,322).

Conclusions:

  • Patients admitted with infective endocarditis after the COVID-19 onset were more medically complex, exhibiting worsened outcomes and higher mortality.
  • Conversely, patients undergoing valve surgery for IE demonstrated improved mortality and stable outcomes despite the pandemic's challenges.
  • These findings highlight a divergence in pandemic impact based on IE management strategy, emphasizing the resilience of surgical interventions.

Keywords:
COVID-19infective endocarditisvalve surgery

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