A Quarter-Century Mortality Analysis of Concomitant Infective Endocarditis and Stroke in the United States – A Nationwide CDC WONDER Study

BACKGROUND: Patients with infective endocarditis (IE) face an elevated risk of cerebrovascular disease; however, national trends in mortality related to both cerebrovascular disease and IE remain poorly characterized. This study examines contemporary mortality trends among US adults aged ≥25 years in the United States with coexisting cerebrovascular disease and IE from 1999 to 2024. METHODS: We analyzed the mortality data using the CDC WONDER mortality database, extracting age-adjusted mortality rates (AAMR) per 100,000 population. We identified cerebrovascular disease and IE using the respective ICD-10 codes. We included those fatalities where cerebrovascular disease and IE were either the underlying or the contributing cause. We evaluated the mortality trends by year, sex, race and ethnicity, and census region. Joinpoint regression was used to calculate the annual percent change (APC) in AAMR with 95% confidence intervals. RESULTS: From 1999 to 2024, a total of 43,799 deaths occurred with an overall AAMR of 0.75/100,000. The AAMR increased from 0.83 in 1999 to 0.87 in 2024 (AAPC: 0.44; 95% CI: 0.04 to 0.88; p < 0.05). Joinpoint analysis demonstrated a decreasing trend from 1999 to 2015 (APC: -1.54; 95% CI: -2.53 to -0.76; p < 0.05) and an increasing trend from 2015 to 2024 (APC: 4.05; 95% CI: 2.54 to 7.39; p < 0.05). Men had a higher AAMR (0.86) than women (0.67). Black or African American had the highest AAMR (0.94) compared to other racial groups. The Midwest (0.83) region had the highest AAMR among census regions. CONCLUSION: The mortality related to concomitant cerebrovascular disease and infective endocarditis increased throughout the study period, with a more prominent rise in the last 10 years. These mortality trends warrant further investigation.