What is the clinical evidence from this study?

Study design: Cohort. Population: native valve infective endocarditis (n=18402). Intervention: Valve surgery vs. Medical therapy. Primary outcome: In-hospital all-cause mortality and 5-year all-cause mortality (HR 0.51, 95% CI 0.39-0.66, p=<0.001).

What question did this study set out to answer?

This research aims to explore the changing patterns and outcomes of native valve infective endocarditis (IE) in Korea from 2006 to 2023.

January 10, 2026Open Heart0 citationsOpen Access

From structural heart lesions to host burden: changing epidemiology and outcomes of native valve infective endocarditis, a nationwide study, 2006–2023

Q: What are the key findings of this study?

Surgery for native valve infective endocarditis significantly reduces mortality across all age groups, with persistent benefits in elderly patients.

Q: What does this research mean for the field?

Surgery for native valve infective endocarditis significantly reduces mortality across all age groups, with persistent benefits in elderly patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Q: What question did this study set out to answer?

This research aims to explore the changing patterns and outcomes of native valve infective endocarditis (IE) in Korea from 2006 to 2023.

YKYR KimIncheon St. Mary's Hospital MKMi‐Jeong KimUlsan College JLJungkuk leeHanmi Pharmaceutical (South Korea)

Key Result

Surgery for native valve infective endocarditis significantly reduces mortality across all age groups, with persistent benefits in elderly patients.

Key Points

This research aims to explore the changing patterns and outcomes of native valve infective endocarditis (IE) in Korea from 2006 to 2023.
Conducted an 18-year nationwide cohort study of hospitalized adults with native valve IE in Korea.
Evaluated in-hospital and 5-year all-cause mortality, IE relapse, and composite outcomes.
Utilized multivariable Cox models and stratified survival analyses to identify predictors of mortality.
In-hospital mortality was 25.5%, with over 50% mortality at 5 years.
Incidence decreased in those under 45 but increased in individuals aged 65 and older.
Surgery, performed in 29.1% of patients, was associated with lower mortality and relapse risks across age groups.

Study Design

Type

Cohort (n=18,402)

Multicenter

Yes

Structured PICO

Does valve surgery reduce mortality in adult patients hospitalized with native valve infective endocarditis compared to medical therapy alone?

Population

n=18,402 adult patients (≥18 years) hospitalized with a primary diagnosis of native valve infective endocarditis (IE) at general hospitals with >100 beds in Korea. Excluded: history of prosthetic valve replacement or transcatheter aortic valve replacement. Mean age 63.7 years, 51.8% male.

Intervention

Valve surgery (performed in 29.1% of patients, including early ≤7 days and late >7 days)

Comparator

Medical therapy alone

Outcome

In-hospital all-cause mortality and long-term all-cause mortality up to 5 years after the index admissionhard clinical

In a nationwide Korean cohort, native valve infective endocarditis has shifted toward an older, multimorbid population with high mortality, but valve surgery remains associated with a significant survival benefit across all age groups.

Main Result

Effect estimate: HR 0.51 (95% CI 0.39-0.66)

p-value: p=<0.001

Limitations

Absence of detailed surgical information
Microbiological data lacking
Limited ability to assess individual surgical candidacy
Potential misclassification of antibiotic data
External validity limited due to exclusion of prosthetic valve cases

Abstract

Background The epidemiology of native valve infective endocarditis (IE) has shifted toward older adults with substantial comorbidity burdens, yet contemporary nationwide data on outcomes and surgical impact remain limited. Methods We conducted an 18-year nationwide cohort study of adults hospitalised with native valve IE in Korea (2006–2023). Outcomes included in-hospital and 5-year all-cause mortality, IE relapse and a composite of death or relapse. Temporal trends, mortality predictors and surgical associations across age strata were evaluated using multivariable Cox models and stratified survival analyses. Results Among 18 402 patients (mean age 63.7 years), incidence declined in individuals 7 days) surgery showed reduced mortality versus medical therapy. IE relapse was more frequent in older adults, and surgery was associated with a lower relapse risk. In the composite outcome of death or relapse, older adults had a higher event burden, whereas surgery remained associated with fewer composite events. Conclusions Native valve IE in Korea has shifted toward an elderly, multimorbid population with persistently high mortality. Despite declining utilisation, the survival benefit of surgery was preserved across the age spectrum, supporting operative consideration in appropriately selected older adults.

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