Key result
Age ≥75 linked to ~18-point higher in-hospital mortality in infective endocarditis alongside lower surgical rates.
Why the study?
Infective endocarditis prevalence is rising in the elderly, where higher comorbidity burden and frailty complicate diagnosis and management. This study sought to compare clinical features, microbiology, complications, and outcomes between patients aged ≥75 years and those aged <75 years.
Does age ≥75 years impact clinical features, surgical intervention rates, and mortality in patients with infective endocarditis compared to patients aged <75 years?
Cohort (n=96)
No
Does age ≥75 years impact clinical features, surgical intervention rates, and mortality in patients with infective endocarditis compared to patients aged <75 years?
Elderly patients (≥75 years) with infective endocarditis undergo surgery less frequently and experience higher in-hospital mortality and longer hospital stays than younger patients, though 1-year post-discharge survival is comparable.
Background Infective endocarditis (IE) remains a severe and life-threatening condition, particularly among the elderly population. Its prevalence is rising due to increased life expectancy and the growing use of valvular prostheses and cardiac implantable electronic devices. The higher burden of comorbidities and the frailty common in this population further complicate diagnosis and management. Purpose To compare the clinical features, microbiological results, complications, and outcomes of IE in older patients (≥75 years, Group 1) and younger patients (<75 years, Group 2). Methods Retrospective, single-center, cohort study of patients diagnosed with definite or possible IE (according to the modified Duke criteria) between January 2015 and May 2024 in a local health unit in Portugal. Demographics, comorbidities, echocardiographic findings, microbiological data, treatment, and outcomes were compared. Results Ninety-six patients were included in this study (68% male, median age 71 years [IQR 61-81]). Of these, 43 patients aged ≥75 years were assigned to Group 1. Group 1 patients had a higher prevalence of valvular heart disease (56 vs. 32%, p = 0.019), prior valvular surgery (49 vs. 23%, p = 0.007), and pacemaker implantation (14 vs. 1.9%, p = 0.043). Regarding IE characterization, group 1 patients presented earlier (within one week of symptom onset – 64 vs 40%, p=0.017). The aortic valve was the most frequently affected (57%), with no difference between groups. Group 1 had more cases involving bioprosthetic valves (33 vs. 11%, p=0.011), while Group 2 had more native valve involvement (47 vs. 72%, p=0.012). Positive blood cultures were found in 84% of patients, with no significant difference between groups. The most commonly isolated pathogen was Staphylococcus aureus (17%) (figure 1). Median vegetation size was similar (14 vs. 15 mm, p=0.825). Local and systemic complications occurred in 66 (69%) and 60 (63%) patients, respectively, with no significant difference between groups. Surgery was performed in 35 patients (37%), with a lower surgical intervention rate in Group 1 (19 vs. 51%, p=0.001). The most common indications for surgery were severe valve insufficiency (60%) and local complications (11%). Group 1 patients had a longer median hospital stay (42 vs. 27 days, p = 0.018) and longer time to surgery (67 vs. 38 days, p = 0.012). In-hospital mortality was significantly higher in Group 1 (37% vs. 19%, p = 0.044), but one-year mortality was similar (19% vs. 19%, p = 0.956) (figure 2). Conclusion Older patients with IE had more comorbidities, were less likely to undergo surgical intervention, had longer hospital stays, and experienced higher in-hospital mortality compared to younger patients. Despite these differences, long-term survival after discharge was similar between groups. These findings highlight the need for individualized treatment strategies to optimize outcomes in elderly IE patients.Figure 1Figure 2
No takes yet. Share an insight, caveat, or question.
Vazao et al. (2026) conducted a cohort in Infective endocarditis (n=96). Age ≥75 years vs. Age <75 years was evaluated on In-hospital mortality (p=0.044). Age ≥75 years in infective endocarditis was associated with higher in-hospital mortality (37% vs 19%, p=0.044) and lower surgical rates (19% vs 51%, p=0.001) compared to age <75 years.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: