Infective endocarditis in elderly patients: Analysis of the Spanish Registry of Infective Endocarditis in Internal...

Infective endocarditis (IE) in very elderly patients represents a clinical challenge due to their high comorbidity burden and atypical clinical presentation. The objective of this study was to compare the clinical profile, diagnostic approach, etiology, and outcomes of patients with IE older than 85 years versus those aged 85 years or younger.

A multicenter analysis was conducted using data from the Spanish Interhospital Registry of IE in Internal Medicine (REEIMI), which included 842 patients between 2017 and 2024. Two age groups were compared: one with patients aged 85 years or younger, and another with patients older than 85 years.

Patients over 85 years showed a lower frequency of fever (41.4% vs 54.2%; p<0.01), a higher prevalence of atrial fibrillation (48.8% vs 26.4%; p<0.01), and significantly less use of advanced diagnostic techniques such as computed tomography (1.1% vs 13.1%; p<0.01). A relative predominance of Enterococcus spp. over other pathogens was also observed. Cardiac surgery rates were markedly lower in this group (3.4% vs 44.2%; p<0.01), and 30-day mortality was significantly higher (37.9% vs 20.0%; p<0.01).

These findings highlight the need for an individualized therapeutic approach that considers functional status and frailty in order to optimize clinical decision-making. With a progressively aging population, specific strategies are urgently needed to improve outcomes in this vulnerable group and prevent age-related discrimination.