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It is not how old you are, it is how you are old: need for changes in the management of infective endocarditis in the elderly
  1. Fabio Chirillo
  1. Correspondence to Dr Fabio Chirillo, Direttore SC Cardiologia, Ospedale San Bassiano, Via dei Lotti 40, 36061 Bassano del Grappa (VI), Italy; fchirillo{at}

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The world’s population is ageing at an expedited rate. By the end of the century, a person is expected to live for 81 years in developing nations and 89 years in developed countries where individuals 85 years and older are now the fastest growing part of the population.1 The elderly population has clearly benefited from medical progress; degenerative heart diseases are now successfully treated in the vast majority of elderly patients by means of less invasive techniques with reduced procedural risks and increased survival. However, the increasing number of cardiovascular electronic devices, prosthetic valve and transcatheter aortic valve implantations, along with frequent invasive diagnostic or therapeutic procedures performed in elderly may contribute to the rise of infections such as infective endocarditis(IE). Infections in the elderly represent a major challenge because of atypical clinical presentation, different epidemiology, high frequency and lethality. The management of infection in this population has been poorly explored, and international guidelines do not recommend adapting the therapeutic strategy to the patient’s functional status and comorbidities.

Clinical case series consistently described that older patients with IE tend to have a higher mortality are less likely to have surgery and more likely to have prosthetic devices and infections with bacteria from the gut or urinary tract. Moreover, older people are more likely to present insidiously with smaller vegetations and less embolic manifestations.2–5

However, older age is an ill-defined entity. Most published studies focused on patients aged over 65 years, while few papers have evaluated IE among octogenarians. Oliver et al 6 in their Heart manuscript, present the clinical and microbiological characteristics of IE in the very old (ie, >80 year) patients and compared with old (65–80 years) and adult (<65 years) population. There were some peculiar aspects of IE in the oldest group: Enterococci and Streptococcus gallolyticus were the more frequent …

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