Mortality High for Cardiac Device Infective Endocarditis

Coexisting valve involvement linked with increased mortality; early device removal improves survival

TUESDAY, April 24 (HealthDay News) -- Patients with infective endocarditis involving implanted cardiac devices experience high in-hospital and one-year mortality rates, particularly if there is valve involvement, according to a study published in the April 25 issue of the Journal of the American Medical Association.

Eugene Athan, M.D., from Barwon Health in Geelong, Australia, and colleagues described the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) using data from patients enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study, conducted from June 2000 to August 2006. Participants included 2,760 patients with definite infective endocarditis, defined using the modified Duke endocarditis criteria.

The researchers found that CDIE was diagnosed in 6.4 percent of the cohort (177 patients). Patients with CDIE were older (median age, 71.2 years) and had a high prevalence of health care-associated infection (45.8 percent). CDIE was caused by staphylococci (Staphylococcus aureus, 35 percent; coagulase-negative staphylococci, 31.6 percent). Coexisting valve involvement was seen in 37.3 percent of patients and was mainly tricuspid valve infection (24.3 percent); valve involvement correlated with increased mortality. The in-hospital mortality rate was 14.7 percent and the one-year mortality rate was 23.2 percent. Patients who had their device removed during the initial hospitalization had a survival benefit at one year compared to those who did not undergo device removal (19.9 versus 38.2 percent; hazard ratio, 0.42).

"Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement," the authors write. "Early device removal is associated with improved survival at one year."

Several authors disclosed financial ties to the biopharmaceutical industry.

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