April 26, 2026Open Heart0 citationsOpen Access
View Full PaperSex differences in the diagnosis, management and outcomes of patients with infective endocarditis
Key Result
Female patients with infective endocarditis had higher adjusted mortality than males (aHR 1.39; 95% CI 1.03-1.89; p=0.03), and were more often treated conservatively despite surgical indications.
Key Points
- The study aims to explore sex differences in the diagnosis, management, and outcomes of patients with infective endocarditis.
- Prospective study from 2016 to 2025 including 791 patients with infective endocarditis.
- Comparison of baseline characteristics, diagnostics, treatment, and outcomes between males and females.
- Cox model used to assess adjusted survival considering baseline characteristics, infective endocarditis type, and treatment.
- Females experienced higher overall adjusted mortality (aHR 1.39, 95% CI 1.03 to 1.89, p=0.03).
- Surgery was performed more often in males (41.1% vs 29.3%, p=0.002) and correlated with higher mortality in males (aHR 1.32, 95% CI 0.90 to 1.94).
- Females with surgical indications received conservative treatment more often (22.5% vs 37.0%, p=0.006).
Study Design
Type
Cohort (n=791)
Structured PICO
Does female sex impact survival and surgical management in patients with infective endocarditis?
P
Population
791 patients with definite or possible valvular infective endocarditis (IE) discussed by the endocarditis team from 2016 to 2025 (72.8% males, 27.2% females)
I
Intervention
Female sex
C
Comparator
Male sex
O
Outcome
Survival adjusted for baseline characteristics, IE type and treatmenthard clinical
Female patients with infective endocarditis have worse adjusted survival and are less likely to undergo indicated surgery compared to males.
Main Result
Effect estimate: aHR 1.39 (95% CI 1.03 to 1.89)
p-value: p=0.03
Abstract
Background Despite growing interest in male–female differences in cardiovascular disease, evidence in infective endocarditis (IE) is limited and contradictory. Methods This prospective study included all patients with definite or possible valvular IE discussed by the endocarditis team from 2016 to 2025. Baseline characteristics, diagnostics, treatment and outcomes were compared between sexes. A Cox model was conducted to assess survival adjusted for baseline characteristics, IE type and treatment. Results The cohort included 791 patients with definite or possible IE (72.8% males, 27.2% females). Age was not different (male: 67 (IQR 56–75), female: 71 (IQR 55–78) years, p=0.07). Females more often had hypertension (46.0% vs 35.2%, p=0.07) and mitral valve IE (45.6% vs 32.3%, p<0.001). Males had more predisposing conditions (71.5% vs 60.5%, p=0.004) and more aortic valve IE (71.0% vs 62.3%, p=0.02) and Cutibacterium species (5.7% vs 1.4%, p=0.007). There was no difference in indication for surgery. However, males were more often treated surgically (41.1% vs 29.3%, p=0.002), and females with an indication for surgery were more often treated conservatively (22.5% vs 37.0%, p=0.006). After a median follow-up of 2.1 (IQR 0.4–4.4) years, females had higher mortality (adjusted HR (aHR) 1.39 (95% CI 1.03 to 1.89), p=0.03). Surgery was associated with higher mortality in males (aHR 1.32 (95% CI 0.90 to 1.94) vs aHR 0.62 (95% CI 0.32 to 1.20), p value for interaction=0.03). Conclusions Differences were observed in baseline characteristics, IE type and survival. Females had worse overall adjusted survival, suggesting a less favourable overall prognosis. In terms of surgical decision-making, surgery was withheld more often in females despite surgical indication, and after excluding these patients, surgery appeared more protective in females than in males. These findings may reflect sex differences in surgical selection.