Infective endocarditis in octogenarians-a multicenter analysis†

In an older population, infective endocarditis (IE) tends to present uniquely. In this study, we investigate the clinical presentation, microbiological profile and outcomes of IE in octogenarians.

This multicentre retrospective analysis includes 4917 consecutive patients suffering from IE. We analysed the data on octogenarians undergoing surgery due to IE. Primary outcomes were 30-day mortality and 5-year survival.

We found 4625 (94.1%) were younger than 80 years old, whereas 292 patients (5.9%) were octogenarians. The median age of the non-octogenarian cohort was 65 years (54-73 years), whereas the median age of the octogenarian cohort was 82 years (81-84 years). The median EuroSCORE II was 16.5 (9.5-40.4) in the octogenarian group and 9.7 (4.4-21.5) in the non-octogenarian group (P < 0.001). There was a higher number of males in the non-octogenarian group (P < 0.001). Prosthetic valve endocarditis (P < 0.001) and pacemaker endocarditis (P < 0.001) were higher in the octogenarian group. Streptococcal infections were more frequent in octogenarians (P = 0.033), whereas a significantly higher number of non-octogenarians suffered from blood culture negative IE (P = 0.002).The rate of postoperative adverse cerebrovascular events and postoperative morbidities was comparable between the groups. The 30-day mortality was higher in the octogenarian group (P < 0.001). Survival rates at 1 and 5 years were 48% and 39%, respectively, in the octogenarian group (P < 0.001).

IE in the elderly is associated with a higher risk and may present with a different clinical profile. Although advanced age does play a role in the outcomes of surgery for IE, it alone should not be the sole factor to rule out surgery in this cohort.