CARDIOVASCULAR MEDICINE

Infective endocarditis in Europe: lessons from the Euro heart survey

P Tornos¹, B Iung², G Permanyer-Miralda¹, G Baron², F Delahaye³, Ch Gohlke-Bärwolf⁴, E G Butchart⁵, P Ravaud², A Vahanian²

¹ Hospital Vall d’Hebron, Barcelona, Spain
² Bichat Hospital, Paris, France
³ Hopital Cardiologique, Lyons, France
⁴ Heart Centre, Bad Krozingen, Germany
⁵ University Hospital, Cardiff, UK

Correspondence to:
Correspondence to:
Dr Pilar Tornos
Servei de Cardiologia. Hospital Vall d’Hebron, P Vall d’ Hebron 119-129, Barcelona, 08035 Spain; ptornos{at}vhebron.net

Objectives: To describe the characteristics, treatment, and outcomes of active infective endocarditis (IE) in Europe.

Design: Prospective survey of medical practices in Europe.

Setting: 92 centres from 25 countries.

Patients: The EHS (Euro heart survey) on valvar heart disease (VHD) enrolled 5001 adult patients between April and July 2001. Of those, 159 had active IE.

Results: 118 patients (74%) had native IE and 41 (26%) had prosthetic IE. Mean (SD) age was 57 (16) years. Blood cultures were obtained for 113 patients (71%) before antibiotic treatment was started. Surgery was performed in 52% of patients. Reasons for surgery were heart failure in 60%, persistent sepsis in 40%, vegetation size in 48%, or embolism in 18%. Surgery was for implantation of mechanical prosthesis in 63%, bioprosthesis in 21%, aortic homograft in 5%, and valve repair in 11%. In-hospital mortality was 12.6%, being 10.4% in the medical group and 15.6% in the surgical group. Among the total population of 5001 patients, only 50% of those with native VHD had been educated on endocarditis prophylaxis and only 33% regularly attended dental follow up. Of patients with IE who had had a procedure at risk during the preceding year only 50% had received adequate prophylaxis.

Conclusions: The EHS on VHD shows that patients with active IE have a high risk profile and often undergo surgery. However, there are deficiencies in obtaining blood cultures and applying prophylaxis. Mortality remains high, which is a justification for the improvement of patient management through education and the implementation of guidelines.

Abbreviations: EHS, Euro heart survey; IE, infective endocarditis; NYHA, New York Heart Association; VHD, valvar heart disease

Keywords: endocarditis; evaluation; valve disease

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