November 22nd, 2011

Study Examines Role of Surgery for Infective Endocarditis and Heart Failure

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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