Patients who survive infective endocarditis (IE) are still at substantial risk for other long-term adverse outcomes such as stroke, myocardial infarction (MI) and heart failure, new study results suggested.

The authors, noting that there are no long-term analyses of hard adverse outcomes in IE survivors, identified a total of 10,116 IE survivors from Taiwan's National Health Insurance Research Database during 2000-2009. Mean age in the IE cohort was 54.7 years, and most patients were male (65.7%). Using 1:1 propensity score matching to determine the likelihood of hospitalization for IE, the authors looked at primary outcomes that included hospitalization and principal diagnosis of ischemic and hemorrhagic stroke, HF, and MI, and hospitalization or emergency department visit with a diagnosis of sudden cardiac death and ventricular arrhythmia. Secondary outcomes included repeat IE and all-cause death.

The researchers reported higher risk in IE survivors for a number of outcomes vs. the controls, including ischemic stroke (adjusted HR = 1.59; 95% CI, 1.40-1.80), MI (adjusted HR = 1.44; 95% CI, 1.17-1.79), hemorrhagic stroke (adjusted HR = 2.37; 95% CI, 1.90-2.96), readmission for HF (adjusted HR = 2.24; 95% CI, 2.05-2.43), sudden death or ventricular arrhythmia (adjusted HR = 1.69; 95% CI, 1.44-1.98) and all-cause death (adjusted HR = 2.27; 95% CI, 2.14-2.40). The researchers also reported that male sex (HR = 1.30; 95% CI, 1.14-1.48), drug abuse (HR = 1.50; 95% CI, 1.26-1.79), mechanical valve (HR = 2.11; 95% CI, 1.70-2.62), and bioprosthetic valve replacement (HR = 2.60; 95% CI, 2.16-3.13) were significant risk factors for repeated IE.

"European guidelines recommend the careful monitoring of patients with IE for 1 year after discharge because of the high risk of IE recurrence," the authors concluded. "The results of the current study highlight the substantially increased risk of major adverse cardiovascular events (MACE) in IE survivors. Thus, long-term surveillance of MACE should also be considered, beyond the period of greatest risk for IE recurrence."

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Shih CJ, Chu H, Chao P, et al. Circulation. 2014;doi:10.1161/CIRCULATIONAHA.114.012.717.

Keywords: Myocardial Infarction, Stroke, Propensity Score, National Health Programs, Risk Factors, Emergency Service, Hospital, Substance-Related Disorders, Survivors, Endocarditis, Heart Failure, Taiwan, Hospitalization, Death, Sudden, Cardiac, Arrhythmias, Cardiac

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