Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality-a nationwide study

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Andreas Dalsgaard Jensen, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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  • Lauge Østergaard, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark., Department of Cardiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
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  • Jeppe K Petersen, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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  • Peter Graversen, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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  • Jawad H Butt, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
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  • Henning Bundgaard, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark., Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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  • Claus Moser, Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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  • Morten H Smerup, Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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  • Ivy S Modrau
  • Kasper Iversen, Department of Emergency Medicine, Copenhagen University Hospital Herlev/Gentofte, Herlev, Denmark., Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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  • Niels E Bruun, Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
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  • Christian Torp-Pedersen, Clinical Institutes, Aalborg University, Aalborg, Denmark., Department of Cardiology, Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerød, Denmark., Heart Failure, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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  • Gunnar Gislason, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., The Danish Heart Foundation, Vognmagergade 7, 3. sal, 1120 Copenhagen, Denmark., Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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  • Andrew Wang, Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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  • Sigurdur Ragnarsson, Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
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  • Jonas A Povlsen
  • Lars Køber, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark., Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  • ,
  • Emil L Fosbøl, Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.

BACKGROUND: Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist.

METHODS: We included patients with first-time IE (1999-2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999-2003, 2004-2008, 2009-2013, 2014-2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression.

RESULTS: We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999-2003 to 2014-2018. Compared with 1999-2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96-1.35), OR = 1.20 (95% CI: 1.02-1.42), and OR = 1.10 (95% CI: 0.93-1.29) in 2004-2008, 2009-2013, and 2014-2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999-2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65-1.41), HR = 0.43 (95% CI: 0.28-0.67), and HR = 0.55 (95% CI 0.37-0.83) in 2004-2008, 2009-2013, and 2014-2018, respectively.

CONCLUSIONS: On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased.

OriginalsprogEngelsk
TidsskriftBMC Cardiovascular Disorders
Vol/bind22
Nummer1
Sider (fra-til)338
ISSN1471-2261
DOI
StatusUdgivet - 29 jul. 2022

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© 2022. The Author(s).

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