Incidence of infective endocarditis among patients considered at high risk

Lauge Østergaard; Nana Valeur; Nikolaj Ihlemann; Henning Bundgaard; Gunnar Gislason; Christian Torp-Pedersen; Niels Eske Bruun; Lars Søndergaard; Lars Køber; Emil Loldrup Fosbøl

doi:10.1093/eurheartj/ehx682

Incidence of infective endocarditis among patients considered at high risk

Lauge Østergaard^*, Nana Valeur, Nikolaj Ihlemann, Henning Bundgaard, Gunnar Gislason, Christian Torp-Pedersen, Niels Eske Bruun, Lars Søndergaard, Lars Køber, Emil Loldrup Fosbøl

^*Corresponding author for this work

Department of Clinical Medicine

40 Citations (Scopus)

Abstract

Aims: Patients with prior infective endocarditis (IE), a prosthetic heart valve, or a cyanotic congenital heart disease (CHD) are considered to be at high risk of IE by guidelines. However, knowledge is sparse on the relative risk of IE between these three groups and compared controls. Methods and results: Using Danish nationwide registries (1996-2015), we identified all patients with prior IE, a prosthetic heart valve, or a complex CHD (defined as tetralogy of Fallot, truncus arteriosus, and transposition of great arteries) as well as matched control populations. Patients were followed up until death, end of study period, IE hospitalization, emigration, or a maximum of 10 years of follow-up, whichever came first. Multivariable adjusted Cox proportional hazard analysis was used to compare the risk of IE between the study groups and the matched controls. We included 25 945 patients: 5096 had prior IE, 19 478 had a prosthetic heart valve, and 1371 had complex CHD. The cumulative risk of IE at 10 years of follow-up was 8.8%, 6.0%, and 1.3% for patients with prior IE, a prosthetic valve, and complex CHD, respectively. Patients with prior IE and a prosthetic valve had a significant increased associated risk of IE compared with the matched controls [hazard ratio (HR) 65.4, 95% confidence interval (CI) 43.1-99.1 and HR 19.1, 95% CI 15.0-24.4), respectively]. No events occurred among the matched controls for the complex CHD group and an HR could not be calculated. Conclusion: All IE high-risk groups carried a higher risk of IE than the matched controls from the general population. These results justify the European and American guidelines in considering these groups at high risk of IE.

Original language	English
Journal	European Heart Journal
Volume	39
Issue number	7
Pages (from-to)	623-629
Number of pages	7
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehx682
Publication status	Published - 14 Feb 2018

Keywords

Congenital heart disease
Heart valve surgery
High-risk population
Incidence
Infective endocarditis

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title = "Incidence of infective endocarditis among patients considered at high risk",

abstract = "Aims: Patients with prior infective endocarditis (IE), a prosthetic heart valve, or a cyanotic congenital heart disease (CHD) are considered to be at high risk of IE by guidelines. However, knowledge is sparse on the relative risk of IE between these three groups and compared controls. Methods and results: Using Danish nationwide registries (1996-2015), we identified all patients with prior IE, a prosthetic heart valve, or a complex CHD (defined as tetralogy of Fallot, truncus arteriosus, and transposition of great arteries) as well as matched control populations. Patients were followed up until death, end of study period, IE hospitalization, emigration, or a maximum of 10 years of follow-up, whichever came first. Multivariable adjusted Cox proportional hazard analysis was used to compare the risk of IE between the study groups and the matched controls. We included 25 945 patients: 5096 had prior IE, 19 478 had a prosthetic heart valve, and 1371 had complex CHD. The cumulative risk of IE at 10 years of follow-up was 8.8%, 6.0%, and 1.3% for patients with prior IE, a prosthetic valve, and complex CHD, respectively. Patients with prior IE and a prosthetic valve had a significant increased associated risk of IE compared with the matched controls [hazard ratio (HR) 65.4, 95% confidence interval (CI) 43.1-99.1 and HR 19.1, 95% CI 15.0-24.4), respectively]. No events occurred among the matched controls for the complex CHD group and an HR could not be calculated. Conclusion: All IE high-risk groups carried a higher risk of IE than the matched controls from the general population. These results justify the European and American guidelines in considering these groups at high risk of IE.",

keywords = "Congenital heart disease, Heart valve surgery, High-risk population, Incidence, Infective endocarditis",

author = "Lauge {\O}stergaard and Nana Valeur and Nikolaj Ihlemann and Henning Bundgaard and Gunnar Gislason and Christian Torp-Pedersen and Bruun, {Niels Eske} and Lars S{\o}ndergaard and Lars K{\o}ber and Fosb{\o}l, {Emil Loldrup}",

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doi = "10.1093/eurheartj/ehx682",

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TY - JOUR

T1 - Incidence of infective endocarditis among patients considered at high risk

AU - Østergaard, Lauge

AU - Valeur, Nana

AU - Ihlemann, Nikolaj

AU - Bundgaard, Henning

AU - Gislason, Gunnar

AU - Torp-Pedersen, Christian

AU - Bruun, Niels Eske

AU - Søndergaard, Lars

AU - Køber, Lars

AU - Fosbøl, Emil Loldrup

PY - 2018/2/14

Y1 - 2018/2/14

N2 - Aims: Patients with prior infective endocarditis (IE), a prosthetic heart valve, or a cyanotic congenital heart disease (CHD) are considered to be at high risk of IE by guidelines. However, knowledge is sparse on the relative risk of IE between these three groups and compared controls. Methods and results: Using Danish nationwide registries (1996-2015), we identified all patients with prior IE, a prosthetic heart valve, or a complex CHD (defined as tetralogy of Fallot, truncus arteriosus, and transposition of great arteries) as well as matched control populations. Patients were followed up until death, end of study period, IE hospitalization, emigration, or a maximum of 10 years of follow-up, whichever came first. Multivariable adjusted Cox proportional hazard analysis was used to compare the risk of IE between the study groups and the matched controls. We included 25 945 patients: 5096 had prior IE, 19 478 had a prosthetic heart valve, and 1371 had complex CHD. The cumulative risk of IE at 10 years of follow-up was 8.8%, 6.0%, and 1.3% for patients with prior IE, a prosthetic valve, and complex CHD, respectively. Patients with prior IE and a prosthetic valve had a significant increased associated risk of IE compared with the matched controls [hazard ratio (HR) 65.4, 95% confidence interval (CI) 43.1-99.1 and HR 19.1, 95% CI 15.0-24.4), respectively]. No events occurred among the matched controls for the complex CHD group and an HR could not be calculated. Conclusion: All IE high-risk groups carried a higher risk of IE than the matched controls from the general population. These results justify the European and American guidelines in considering these groups at high risk of IE.

AB - Aims: Patients with prior infective endocarditis (IE), a prosthetic heart valve, or a cyanotic congenital heart disease (CHD) are considered to be at high risk of IE by guidelines. However, knowledge is sparse on the relative risk of IE between these three groups and compared controls. Methods and results: Using Danish nationwide registries (1996-2015), we identified all patients with prior IE, a prosthetic heart valve, or a complex CHD (defined as tetralogy of Fallot, truncus arteriosus, and transposition of great arteries) as well as matched control populations. Patients were followed up until death, end of study period, IE hospitalization, emigration, or a maximum of 10 years of follow-up, whichever came first. Multivariable adjusted Cox proportional hazard analysis was used to compare the risk of IE between the study groups and the matched controls. We included 25 945 patients: 5096 had prior IE, 19 478 had a prosthetic heart valve, and 1371 had complex CHD. The cumulative risk of IE at 10 years of follow-up was 8.8%, 6.0%, and 1.3% for patients with prior IE, a prosthetic valve, and complex CHD, respectively. Patients with prior IE and a prosthetic valve had a significant increased associated risk of IE compared with the matched controls [hazard ratio (HR) 65.4, 95% confidence interval (CI) 43.1-99.1 and HR 19.1, 95% CI 15.0-24.4), respectively]. No events occurred among the matched controls for the complex CHD group and an HR could not be calculated. Conclusion: All IE high-risk groups carried a higher risk of IE than the matched controls from the general population. These results justify the European and American guidelines in considering these groups at high risk of IE.

KW - Congenital heart disease

KW - Heart valve surgery

KW - High-risk population

KW - Incidence

KW - Infective endocarditis

U2 - 10.1093/eurheartj/ehx682

DO - 10.1093/eurheartj/ehx682

M3 - Journal article

C2 - 29244073

AN - SCOPUS:85044128539

SN - 0195-668X

VL - 39

SP - 623

EP - 629

JO - European Heart Journal

JF - European Heart Journal

IS - 7

ER -

Incidence of infective endocarditis among patients considered at high risk

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