Failure of provision of antibiotic prophylaxis for 'at risk' cardiac patients: impetus for improvement required from cardiologists.

We conducted a survey by questionnaire to assess whether patients 'at risk' from infective endocarditis are aware of the need for good dental hygiene and antibiotic prophylaxis, and receive appropriate advice or treatment. Of 189 patients surveyed, half had told a dentist about their heart, 8% were aware of a dental problem, 12% had attended a dentist within one year, but 39% had not attended a dentist in 5 years. Only 21% accurately recalled instructions on prophylaxis and 44% recalled receiving antibiotics prior to treatment. Of replies from 262/480 general practitioners, half took a dental history but only 3% gave antibiotic advice in writing. Fifty-seven percent prescribed antibiotics recommended by the British Society for Antimicrobial Chemotherapy. Of the general practitioners and 72/240 dentists who replied, half were unaware of some of the cardiac conditions requiring prophylaxis, and did not receive adequate advice from their cardiac centre. We conclude most at-risk patients are unaware of the need for good dental hygiene and antibiotic prophylaxis. Communication needs to be improved to address these problems. A new 'endocarditis risk' card is proposed for patients to carry, with an identical 'sticker' to attach to medical notes.