Evolution of Management and Outcomes of Infective Endocarditis After Introducing the Endocarditis Team

Area of Science:

• Cardiology
• Infectious Diseases
• Clinical Management

Background:

• Current guidelines advocate for multidisciplinary endocarditis teams (ETs) for infective endocarditis (IE) patient management.
• While ET benefits are recognized, their temporal evolution and impact on patient care over time require investigation.

Purpose of the Study:

• To analyze the changes in IE management and patient outcomes over time within a dedicated ET framework.
• To assess the impact of increasing ET experience and evolving diagnostic modalities on IE treatment and survival.

Main Methods:

• A prospective study included 1,042 IE patients discussed by an ET from 2016 to 2024, divided into three cohorts.
• Trends in discussion frequency, diagnostic methods (including CT and PET-CT), treatment recommendations, and patient outcomes were analyzed using regression models.

Main Results:

• Referrals and rediscussions by the ET increased significantly over time, indicating greater team engagement.
• Usage of advanced imaging like cardiac CT and PET-CT increased, while recommendations for additional diagnostics and treatment changes decreased.
• Despite changes in diagnostic approaches, IE relapse, reinfection rates, and one-year survival (around 80%) remained stable.

Conclusions:

• Increased ET familiarity and a learning effect are suggested by more referrals and fewer recommendations for further advice.
• The adoption of advanced imaging (CT, PET-CT) has increased, but overall mortality for IE patients remains high.
• The study highlights the evolving role of ETs in IE management and the persistent challenge of high mortality rates.