The influence of social deprivation in infective endocarditis: a retrospective observational study of the London endocarditis research network

Infective endocarditis (IE) remains associated with high mortality despite diagnostic & therapeutic advances. The impact of social deprivation (SD), a key determinant of cardiovascular health, remains unclear. We evaluated the influence of SD in IE within a universal healthcare system. 1740 IE patient visits from three centers in London (King's College Hospital NHS Foundation Trust, Guy's & St. Thomas' NHS Foundation Trust and Barts Health NHS Trust) between December 2013 and March 2023 were included. SD was measured using the Index of Multiple Deprivation, with patients stratified into High (N = 638), Medium (N = 576) and Low (N = 526) groups. Patient and admission characteristics, diagnostic imaging, clinical management, outcomes and variables influencing mortality were assessed. All-cause mortality at 30 days and 1 year was significantly higher in the High SD group (P = 0.030 and P = 0.004 respectively). The high SD group were more likely to be female (P < 0.001), from Asian (P < 0.001) or Black (P < 0.001) self-reported racial groups and had more co-morbidity, including more people who inject drugs (P < 0.001). The high SD group presented with higher white cell count (P = 0.025), C-reactive protein (P = 0.001) and higher rates of right-sided IE (P = 0.028). A causative organism was established in 77.1% of cases, with no differences between groups. There were significantly lower rates of surgery in the High SD group (P < 0.001), and significantly more patients managed conservatively despite having a surgical indication (P = 0.003). These findings suggest that greater co-morbidity, higher inflammatory markers and reduced surgical intervention contribute to higher mortality in socially deprived patients within a universal healthcare system.