Perspective:

In 2007, the AHA published updated guidelines for IE prevention that markedly reduced the use of antibiotic prophylaxis in most at-risk patients undergoing dental and other invasive procedures. The guideline revision was based not on data suggesting that IE prophylaxis was ineffective or deleterious, but based on absence of data proving efficacy. Some clinicians have felt that, in the absence of compelling data for or against prophylaxis efficacy, informed patient decision making might be an appropriate (and ethical) option (see Methodist DeBakey Cardiovasc J 2010;6:48-52). Despite its conclusions, the present publication probably sheds little light on the important question of whether the 2007 guideline change has resulted in a change in IE incidence. With only 22 cases of VGS-IE diagnosed over a 12-year interval, the experience of Olmsted County is not powerful enough to have reliably detected a change in incidence of this relatively uncommon disease. This, combined with an apparent decline in the incidence of IE predating the guideline change (probably due to a change in the prevalence of at-risk valve disease) and unknown levels of adherence to the revised guidelines, leaves this important issue still open to debate.