Implications of the healthcare pathway in infective endocarditis: beginning to see what we do not know

Despite improvements in diagnosis and treatment, and compared with other cardiovascular diseases, mortality from infective endocarditis (IE) has not dramatically declined.1,2 The reasons are numerous and, from an epidemiological perspective, include changing pathogens and patients.3,4 However, given the heterogeneity of presentations and seemingly disparate organ involvement, treatment of endocarditis has been perennially humbling.5 Accordingly, collaboration across subspecialties is essential to improve recognition and implementation of best practices.6 In this setting, optimal application of healthcare pathways within a multidisciplinary IE team might also substantially improve outcomes, though is admittedly difficult to quantify given the varied course of IE. In the current manuscript, Florent et al.7 have provided further insights into the potential advantages of dedicated healthcare pathways in the management and prognosis of patients with IE. Importantly, the authors have included an in-depth analysis of a population where few data are available—patients who are treated exclusively in community-based non-referral centres. In a contemporary, prospective multicentre cohort study of over 300 patients, Florent et al. categorized patients into three groups: those treated only in a referral centre, those transferred to a referral centre, and those treated exclusively in a non-referral centre. Among these groups, the aims were two-fold and included assessing all-cause mortality at 1 year and the implementation of European Society of Cardiology (ESC) IE Guidelines.8