Short- and Long-Term Outcomes of Patients Admitted with Infective Endocarditis Who Undergo Patient-Directed Discharge: A Retrospective Cohort Study

Abstract Background There is an increase of patients with infective endocarditis who undergo patient-directed discharge prior to completion of the recommended duration of parenteral antibiotics. Outcomes of patients with infective endocarditis who do or do not undergo patient-directed discharge have not been clearly elucidated. Methods A retrospective cohort study was done on all adult patients with infective endocarditis admitted at a single center between 2010–2020 who did or did not undergo patient-directed discharge. The authors compared baseline characteristics as well as 30-day, 90-day, 1-year, and 2-year outcomes. Results A total of 389 patients were included, with 47 in the patient-directed discharge cohort and 342 in the non-patient-directed discharge cohort. The patient-directed discharge cohort was younger and more likely to use intravenous drugs, but less likely to suffer from chronic diseases. The patient-directed discharge cohort was more likely to be infected with S. aureus, to experience right-sided valvular disease, and to receive less parenteral antibiotics. While there was no significant difference in mortality, the patient-directed discharge cohort had increased risk of complications. Conclusions Patients with infective endocarditis who undergo patient-directed discharge have significantly different baseline characteristics and are more likely to have complications of infective endocarditis when compared to non-patient-directed discharge, but with no significant difference in mortality.