Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2014;67:380-6 - Vol. 67 Num.05 DOI: 10.1016/j.rec.2013.09.010

Influence of a Multidisciplinary Alert Strategy on Mortality Due to Left-sided Infective Endocarditis

Fernando Carrasco-Chinchilla a, Gemma Sánchez-Espín a, Josefa Ruiz-Morales b, Isabel Rodríguez-Bailón a, Jose M. Melero-Tejedor a, Rada Ivanova-Georgieva b, Victoria García-López c, Antonio Muñoz-García a, Juan J. Gómez-Doblas a, Eduardo de Teresa-Galván a

a Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
b Unidad de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Spain
c Unidad de Microbiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain

Keywords

Endocarditis. Complications. Echocardiography.

Abstract

Introduction and Objectives

Mortality from left-sided infective endocarditis remains very high. The aim of this study was to assess the impact of a multidisciplinary alert strategy (AMULTEI), based on clinical, echocardiographic and microbiological findings, implemented in 2008 in a tertiary hospital.

Methods

Cohort study comparing our historical data series (1996-2007) with the number of patients diagnosed with left-sided endocarditis from 2008-2011 (AMULTEI).

Results

The AMULTEI cohort included 72 patients who were compared with 155 patients in the historical cohort. AMULTEI patients were significantly older (62.5 vs 57.9 years in the historical cohort; P=.047) and had higher comorbidity (Charlson index, 3.33 vs 2.58 in the historical cohort; P=.023). There was also a trend toward more enterococcal etiology in the AMULTEI group (20.8% vs 11.6% in the historical cohort; P=.067). In the AMULTEI group, early surgery was more frequently performed (48.6% vs 23.2%; P<.001) during hospitalization, the incidence of septic shock was significantly lower (9.7% vs 24.5%; P=.009) and there was a trend toward reductions in neurological complications (19.4% vs 29.0%; P=.25) and severe heart failure (12.5% vs 18.7%; P=.24). In-hospital mortality and mortality during the first month of follow-up were significantly lower in the AMULTEI group (16.7% vs 36.1%; P=.003).

Conclusions

Despite the trend toward older age and more comorbidity measured by the Charlson index, early mortality was significantly lower in patients treated with the AMULTEI strategy.

1885-5857/© 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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