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The clinical value of the endocarditis team: insights from before and after guidelines implementation strategy

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Abstract

Purpose

To evaluate the impact of a multidisciplinary the “Endocarditis Team” (ET) on the course and outcome of infective endocarditis (IE) patients.

Methods

A retrospective before–after study, including hospitalized patients with definite IE, managed before (01.2013–12.2015) and after (01.2016–07.2019) the introduction of an ET. The primary outcomes were defined as 30-day and 1-year mortality and the secondary as conservative vs. invasive strategy, the interval from clinical suspicion of IE to the performance of echocardiography, utilization of multimodality evaluation, time to an invasive procedure, and the duration of hospitalization.

Results

Study population included 92 pre-ET and 128 post-ET implementation patients. Baseline characteristics were similar. During the post-ET period compared with pre-ET, we found higher rates of abscesses and extra-cardiac emboli (27.8% vs. 16.3%, p = 0.048); and a higher invasive procedures rate, including lead extraction (15.6% vs. 6.5%, p = 0.035) and noncardiac surgeries (14.8% vs. 6.5%, p = 0.05). Patients managed during the post-ET period had reduced short (8.5% vs. 17.4%, p = 0.048) and long-term mortality (Log-rank = 0.001). In multivariate analysis of risk factors for long-term mortality, period (pre- or post-ET) was not found to be significantly associated with the mortality.

Conclusion

Establishment of an ET was associated with faster and more intensive evaluation of patients with IE. During the period of an ET activity, mortality rates were reduced compared with the previous period.

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Abbreviations

CIED:

Cardiac implanted electronic devices

ET:

Endocarditis team

IE:

Infective endocarditis

F18 :

FDG PET CT−8F-fluorodeoxyglucose positron emission tomography/computed tomography

TOE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

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Authors and Affiliations

  1. Department of Cardiology, Rambam Health Care Campus, Haifa, Israel

    Boaz Elad

  2. Cardiology Department, Rabin Medical Center, 39 Jabotinsky St. 49100, Petach Tikva, Israel

    Leor Perl, Ashraf Hamdan, Yaron Shapira, Mordehay Vaturi, Hadas Ofek, Alexander Sagie, Ran Kornowski & Katia Orvin

  3. Infectious Diseases Unit, Rabin Medical Center, Petach Tikva, Israel

    Dafna Yahav, Alaa Atamna & Hila Shaked

  4. Cardiothoracic Surgery, Rabin Medical Center, Petach Tikva, Israel

    Victor Rubchevsky & Ram Sharony

  5. Nuclear Medicine Department, Rabin Medical Center, Petach Tikva, Israel

    Hanna Bernstine

  6. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Leor Perl, Ashraf Hamdan, Dafna Yahav, Alaa Atamna, Hila Shaked, Victor Rubchevsky, Ram Sharony, Hanna Bernstine, Yaron Shapira, Mordehay Vaturi, Hadas Ofek, Alexander Sagie, Ran Kornowski & Katia Orvin

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  1. Boaz Elad
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Correspondence to Katia Orvin.

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Elad, B., Perl, L., Hamdan, A. et al. The clinical value of the endocarditis team: insights from before and after guidelines implementation strategy. Infection 50, 57–64 (2022). https://doi.org/10.1007/s15010-021-01636-3

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  • DOI: https://doi.org/10.1007/s15010-021-01636-3

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