Study Examines Role of Surgery for Infective Endocarditis and Heart Failure

November 22nd, 2011

Study Examines Role of Surgery for Infective Endocarditis and Heart Failure

Larry Husten, PHD

Although current guidelines recommend valve surgery for patients with infective endocarditis and heart failure (HF), a large prospective registry finds that many of these patients do not undergo surgery — and have much worse outcomes.

In a paper published in JAMA, Todd Kiefer and colleagues report on 4166 patients with infective endocarditis enrolled in the International Collaboration on Endocarditis – Prospective Cohort Study. One third of the patients had HF, yet only 61.7% of these had valve surgery. In-hospital mortality was 29.7% for all patients with HF, but it was significantly lower in the surgical group than in the medical therapy group: 20.6% versus 44.8% (p<0.001). At 1 year, the difference in mortality was larger: 29.1% versus 58.4% (p<0.001). The investigators report that the association between surgery and survival “was apparent across the spectrum of HF severity.”

The authors write that their results support the need for “multidisciplinary, guideline-based management of infective endocarditis.”

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November 22nd, 2011