Socio-Economic Variations Determine the Clinical Presentation, Aetiology and Outcome of Infective Endocarditis: a Prospective Cohort Study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) Registry.
[en] BACKGROUND: Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multi-centre registry. METHODS: The EurObservationalProgramme (EORP) of the European Society of Cardiology (ESC) EURO-ENDO registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in 3 groups, according to World Bank economic stratification (Group 1 - high income [75.6%]; Group 2 - upper-middle income [15.4%]; Group 3 - lower-middle income [9.1%]). RESULTS: Group 3 patients were younger (median age [IQR]: Group 1 - 66 [53-75] years; Group 2 - 57 [41-68] years; Group 3 - 33 [26-43] years; p<0.001) with a higher frequency of smokers, intravenous drug use and human immunodeficiency virus (HIV) infection (all p<0.001) and presented later (median [IQR) days since symptom onset: Group 1 - 12 [3-35]; Group 2 - 19 [6-54]; Group 3 - 31 [12-62]; p<0.001) with a higher likelihood of developing congestive heart failure (13.6%; 11.1%; and 22.6%, respectively; p<0.001) and persistent fever (9.8%; 14.2%; 27.9%; p<0.001). Among 2157 (69.3%) patients with theoretical indication for cardiac surgery, surgery was performed less frequently in Group 3 patients (75.5%, 76.8% and 51.3%, respectively p<0.001) who also demonstrated the highest mortality (15.0%, 23.0% and 23.7%, respectively; p<0.001). CONCLUSIONS: Socio-economic factors influence the clinical profile of patients presenting with IE across the world. Despite younger age, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and lower use of surgery.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Sengupta, Shantanu P; Sengupta Hospital and Research Institute, Ravinagar, Nagpur, India.
Prendergast, Bernard ; Department of Cardiology, St Thomas' Hospital, London, UK.
Laroche, Cécile; EurObservational programme, European Society of Cardiology, Sophia-Antipolis,
Furnaz, Shumaila; Department of Research,National Institute of Cardiovascular diseases Karachi,
Ronderos, Ricardo; ICBA Instituto cardiovascular, Buenos Aires, Argentina.
Almaghraby, Abdallah; University of Alexandria, Egypt.
Asch, Federico M; MedStar Health Research Institute, Washington, DC. USA.
Blechova, Kamila; Department of Cardiac Surgery,Hospital Na Homolce,Prague, Czech republic.
Zaky, Hosam; Dubai Hospital, Dubai, UAE.
Strahilevitz, Jacob; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew
Dworakowski, Rafal; Department of Cardiology, Kings College Hospital, London, UK.
Miyasaka, Yoko; Cardiovascular Division, Department of Medicine II, Kansai Medical University,
Sebag, Igal; Jewish General Hospital, Montreal, Canada.
Izumi, Chisato; National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka,
Axler, Olivier; Department of Cardiology, Centre Hospitalier Territorial Gaston Bourret Médipôle
Jamiel, Abdulrahman; King Saud bin Abadulaziz University for health specialities, Ministry of National
Philip, Mary; Cardiology Department, CHU, Timone, Marseille, France.
Campos Vieira, Marcelo Luiz; Hospital Israelita Albert Einstein, São Paulo,Brazil and Incor, Heart Institute,
LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and
Socio-Economic Variations Determine the Clinical Presentation, Aetiology and Outcome of Infective Endocarditis: a Prospective Cohort Study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) Registry.
Publication date :
12 March 2022
Journal title :
European Heart Journal: Quality of Care and Clinical Outcomes
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