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76 Medical management of infective endocarditis by a multidisciplinary endocarditis team’ improves survival: findings from a before-after study
  1. Amit Kaura1,
  2. Jonathan Byrne2,
  3. Amanda Fife2,
  4. Ranjit Deshpande2,
  5. Max Baghai2,
  6. Margaret Gunning2,
  7. Donald Whitaker2,
  8. Mark Monaghan2,
  9. Philip MacCarthy2,
  10. Olaf Wendler2,
  11. Rafal Dworakowski2
  1. 1Imperial College Healthcare NHS Trust
  2. 2King’s College Hospital NHS Foundation Trust


Introduction Despite improvements in its management, infective endocarditis (IE) is associated with poor survival. The aim of this study was to evaluate the impact of a multidisciplinary endocarditis team (ET), including a cardiologist, microbiologist and a cardiac surgeon, on the outcome of patients with acute IE according to medical or surgical treatment strategies.

Methods We conducted an observational before-after study of 196 consecutive patients with definite IE, who were treated at a tertiary reference centre between 2009 and 2015. The study was divided into 2 periods: period 1, before the formation of the ET (n=101), and period 2, after the formation of the ET (n=95). The role of the ET included regular multidisciplinary team meetings to confirm diagnosis, inform the type and duration of antibiotic therapy and recommend early surgery, when indicated, according to European guidelines (figure-1).

Results The patient demographics and predisposing conditions for IE were comparable between the two study periods (table-1). In the time period following the Introduction of the ET, there was a reduction in both the time to commencement of IE-specific antibiotic therapy (4.0±4.0 days vs 2.5±3.2 days; p=0.004) and the time from suspected IE to surgery (7.8±7.3 days vs 5.3±4.2 days; p=0.004). 12 month Kaplan-Meier survival for patients managed medically was 42.9% in the pre-ET period and 66.7% in the post-ET period (p=0.03) (figure-2). In multivariate Cox regression analysis, the involvement of the ET was a significant independent predictor of 1 year survival in patients managed medically (HR 0.24, 95% CI 0.07–0.87; p=0.03).

Abstract 76 Table 1 Demographic, clinical, microbiology and echocardiographic characteristics of patients with definite endocarditis according to study period

Abstract 76 Figure 1 Referral pathway and journey of patients with infective endocarditis

Abstract 76 Figure 2 Kaplan-Meier survival curves comparing survival between the pre-ET and post-ET time periods in medically managed patients with infective endocarditis

Conclusions A standardised multidisciplinary team approach may lead to earlier diagnosis of IE, more appropriate individualised management strategies, expedited surgery, where indicated, and improved survival in those patients chosen for medical management, supporting the recent change in European Society of Cardiology guidelines to recommend the use of a multidisciplinary team in the care of patients with IE.

  • Infective endocarditis
  • Mortality
  • Multidisciplinary team

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