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Sex Differences in Clinical Outcomes and Surgical Interventions for Infective Endocarditis: A Nationwide Registry
Ching-Yi Lin1, Feng-Cheng Chang2, Chun-Yu Chen2
1Department of Medical Education, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Open Forum Infectious Diseases
|August 27, 2025
Summary
Women with infective endocarditis (IE) face higher in-hospital mortality and surgical complications. While overall survival is better, surgical intervention leads to worse long-term outcomes for women, necessitating sex-specific care strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Health Outcomes Research
Background:
- Sex differences in infective endocarditis (IE) outcomes are understudied.
- Existing research on surgical IE outcomes shows inconsistencies.
- Critical knowledge gaps exist regarding sex-based disparities in IE management and survival.
Purpose of the Study:
- To investigate sex-based differences in clinical outcomes for patients with infective endocarditis.
- To analyze in-hospital and long-term survival rates between women and men with IE.
- To compare outcomes in patients undergoing valve surgery for IE, focusing on sex disparities.
Main Methods:
- Nationwide cohort study using Taiwan's National Health Insurance Research Database (2001-2022).
- Inclusion of 28,976 adult patients diagnosed with IE.
- Subgroup analysis of 4,133 patients undergoing valve surgery, with logistic regression and Cox models for outcome analysis.
Main Results:
- Women with IE were older and had more comorbidities.
- Propensity score matching revealed higher in-hospital mortality for women in both general (21.2% vs 19.8%) and surgical (20.7% vs 13.3%) cohorts.
- Women undergoing surgery experienced more perioperative complications and worse long-term outcomes (HR: 1.12) and higher rates of redo valve surgery (HR: 1.43).
Conclusions:
- Women with IE exhibit higher in-hospital mortality, irrespective of surgical intervention.
- Surgical intervention in women with IE is associated with increased perioperative complications and poorer long-term survival.
- Findings underscore the need for sex-specific IE management strategies, including early diagnosis, timely surgery, and enhanced follow-up care.
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