The changing prognosis of infectious endocarditis in the endocarditis Team Era. a 15-year analysis

Background Infective endocarditis (IE) is a life-threatening condition with high in-hospital mortality rates. In recent decades, the implementation of endocarditis teams has been proposed as a multidisciplinary approach to improve patient outcomes. Our aim was to evaluate prognosis over a fifteen-year period in a national cohort. Methods Our data come from the Spanish endocarditis registry. We included 6525 patients diagnosed with IE between 2008 and 2022. Clinical characteristics, complications, and mortality rates were compared in four periods (2008-2011, 2009-2014, 2015-2017, 2018-2022). Results We found a worsening of the clinical profile during the four periods, with an increase of median age (68-69-69-70 years, p=0.007), age-adjusted Charlson comorbidity index (4-5-5-5, p <0.001), prosthetic valve IE rate (29-31-32-33%, P=0.029) and intracardiac complications rate (27-30-37-38%, p<0.001), and a decrease in the rate of cardiac implantable electronic devices infections (11-11-9-8%, p=0.012). However, the rate of surgical interventions increased (45-45-49-51%, p<0.001) and the median number of days from diagnosis to surgery decreased (12-10-9-9. P=0.001). Inhospital death decreased in the overall population (27-25-25-23%, p=0.037) and in high risk patients as those aged 70-77 years (31-32-28-23, p=0.04), ≥78 years (36-33-34-30, p=0.07), Charlson index ≥7 (38-39-38-31, p=0.02), treated with surgery (22-21-18-18, p=0.02), and prosthetic valve IE (32-27-30-25, p=0.001). One-year mortality also decreased (36-35-33-28%, p=0.008). Year period was an independent risk factor for inhospital mortality (odds ratio 0.97, 95% confidence interval 0.95-0.98, p <0.001) and one-year mortality (hazard ratio 0.93, 95% confidence interval 0.88-0.99, p=0.016) Conclusions Despite a worsening clinical profile, IE inhospital and one-year mortality seem to be decreasing. The introduction of endocarditis teams and an increase in surgical interventions might contribute to this better prognosis. Our findings suggest that adopting a multidisciplinary team approach could be a critical strategy in improving outcomes for patients with IE.