Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
Cardiology Department, Rabin Medical Center, 39 Jabotinsky St. 49100, Petach Tikva, Israel.
Infection. 2022 Feb;50(1):57-64. doi: 10.1007/s15010-021-01636-3. Epub 2021 Jun 5.
To evaluate the impact of a multidisciplinary the "Endocarditis Team" (ET) on the course and outcome of infective endocarditis (IE) patients.
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.
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.
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.
评估多学科“心内膜炎团队”（ET）对感染性心内膜炎（IE）患者病程和结局的影响。
这是一项回顾性前后对照研究，纳入了经明确诊断的 IE 住院患者，分别在 ET 建立前（2013 年 1 月至 2015 年 12 月）和建立后（2016 年 1 月至 2019 年 7 月）进行管理。主要结局定义为 30 天和 1 年死亡率，次要结局定义为保守与侵入性策略、从 IE 临床怀疑到超声心动图检查的时间、多模式评估的应用、侵入性操作的时间以及住院时间。
研究人群包括 92 例 ET 建立前和 128 例 ET 建立后患者。基线特征相似。与 ET 建立前相比，ET 建立后患者的脓肿和心脏外栓塞发生率更高（27.8% vs. 16.3%，p=0.048），侵入性操作率更高，包括心脏起搏器或除颤器取出术（15.6% vs. 6.5%，p=0.035）和非心脏手术（14.8% vs. 6.5%，p=0.05）。ET 建立后管理的患者短期（8.5% vs. 17.4%，p=0.048）和长期死亡率（Log-rank=0.001）降低。多因素分析长期死亡率的危险因素时，发现时期（ET 建立前或后）与死亡率无显著相关性。
建立 ET 与更快、更强化的 IE 患者评估相关。在 ET 活动期间，与前一时期相比，死亡率降低。
