Age and New York Heart Association Class as Predictors of Surgical Outcomes in Patients With Infective Endocarditis

Background Infective endocarditis is a life-threatening cardiovascular condition with high morbidity and mortality rates. Despite advances in surgical and medical care, outcomes vary widely, particularly among older patients and those with impaired cardiac function. The New York Heart Association (NYHA) classification is commonly used to assess functional status, and age is an established predictor of adverse postoperative outcomes. Objective To evaluate whether age and NYHA functional class are independently associated with postoperative recovery and 30-day mortality among patients undergoing surgery for infective endocarditis at a tertiary care center. Methodology This retrospective cohort study included adult patients diagnosed with infective endocarditis and treated surgically at the Peshawar Institute of Cardiology between January 2022 and December 2024. Patients were classified into high-risk (age ≥65 years and/or NYHA class III/IV) and low-risk (age <65 years and NYHA class I/II) groups. The primary outcome was recovery, defined as discharge without major complications, including reoperation or prolonged hospitalization beyond 14 days of surgery. The secondary outcome was 30-day mortality rate. Statistical analysis included chi-squared tests and multivariate logistic regression adjusted for sex, body mass index, diabetes mellitus, and hypertension. Model validity was assessed using the Hosmer-Lemeshow goodness-of-fit test and the area under the curve (AUC). Results Of the 260 patients, 130 (50.0%) were classified as high-risk. Recovery was significantly lower in the high-risk group than in the low-risk group (70.0% vs. 90.0%, P < 0.001), with 95% confidence intervals (CIs) of 62.0-77.1 and 83.7-94.5, respectively. Thirty-day mortality was higher in the high-risk group (15.4% vs. 5.4%, P = 0.002; 95% CI: 9.9-22.8 and 2.4-10.7, respectively). On multivariate analysis, age and NYHA class were independently associated with recovery and mortality (e.g., NYHA III/IV: odds ratio (OR) for mortality 3.50, 95% CI: 1.50-8.17; P = 0.004). Conclusions Advanced age and higher NYHA class were independently associated with poorer short-term surgical outcomes in patients with infective endocarditis. These simple, routinely available variables can be integrated into preoperative assessments to improve perioperative risk stratification and guide individualized surgical planning, particularly in resource-limited settings.