Long-Term Prognostic Impact of Sex in Patients with Chronic Coronary Syndrome: A 17-Year Prospective Cohort Study.

Background: Women and men with chronic coronary syndrome (CCS) have different clinical features and management, and studies on mid-term prognosis have reported conflicting results. Our objective was to investigate the impact of the female sex in the prognosis of the disease in the very long term. Methods and Results: We investigated differential features and very long-term prognosis in 1268 consecutive outpatients with CCS (337 [27%] women and 931 [73%] men). Women were older than men, more likely to have hypertension, diabetes, angina, and atrial fibrillation, and less likely to be exsmoker/active smoker and to have been treated with coronary revascularization (p < 0.05 for all). The prescription of statins, antiplatelets, and betablockers was similar in both groups. After up to 17 years of follow-up (median = 11 years, interquartile range = 4-15 years), cumulative incidences of acute myocardial infarction (10.2% vs. 11.8%) or stroke (11% vs. 10%) at median follow-up were similar, but the risks of major cardiovascular events (acute myocardial infarction, stroke, or cardiovascular death, 41.2% vs. 33.6%), hospital admission for heart failure (20.9% vs. 11.9%), or cardiovascular death (32.3% vs. 22.1%) were significantly higher for women (p < 0.0005), with a nonsignificant trend to higher overall mortality (45.2% vs. 39.1%, p = 0.07). However, after multivariate adjustment, all these differences disappeared. Conclusion: Although women and men with CCS presented a different clinical profile, and crude rates of major cardiovascular events, heart failure and cardiovascular death were higher in women, female sex was not an independent prognostic factor in this study with up to 17 years of follow-up.

[Should Angiotensin-converting enzyme inhibitors be continued over the long term in patients whose left ventricular ejection fraction normalizes after an episode of acute myocarditis?]. / Se deben mantener los inhibidores de la enzima de conversión de la angiotensina a largo plazo en pacientes que normalizan la fracción de eyección tras un episodio de miocarditis aguda?

It is well established that long-term administration of angiotensin-converting enzyme (ACE) inhibitors has a favorable effect in patients with chronic heart failure and dilated cardiomyopathy. However, less information is available on patients whose left ventricular ejection fraction normalizes after an episode of systolic dysfunction secondary to acute myocarditis. We followed 35 patients who were diagnosed at our center between 1987 and 1995 with acute myocarditis and an ejection fraction<45%. All were taking ACE inhibitors. After 34 (23) months of follow-up, the left ventricular ejection fraction was >50% in all 35 patients. Treatment with ACE inhibitors was discontinued in 15 of the 35 patients, while the other 20 continued ACE inhibitor therapy. After 3 years of follow-up, no death had occurred, but the incidence of new episodes of heart failure with a left ventricular ejection fraction<45% was higher in patients who stopped taking ACE inhibitors (33% vs 5%, P=.064), and their ejection fraction was lower (47 [12%] vs 57 [11%], P=.002). These results suggest that ACE inhibitors should be continued over the long term in these patients.

[Oral anticoagulation for nonvalvular atrial fibrillation: are scientific recommendations effective and safe in daily clinical practice?]. / Anticoagulación oral en la fibrilación auricular no valvular: 'son efectivas y seguras las recomendaciones científicas en la práctica clínica diaria?

INTRODUCTION AND OBJECTIVES: To study the efficacy and safety of an oral anticoagulation protocol for the treatment of nonvalvular atrial fibrillation, based on scientific associations' recommendations, in unselected patients seen in daily clinical practice. METHODS: The study included all consecutive patients with permanent nonvalvular atrial fibrillation who attended two outpatient cardiology clinics between February 1, 2000 and February 1, 2002. They were treated according to an anticoagulation protocol based on Spanish Society of Cardiology and American College of Cardiology/American Heart Association/European Society of Cardiology guidelines. Patients were followed up prospectively for major events, such as death, stroke, transient ischemic attack, peripheral embolism and severe hemorrhage, which were recorded by treatment group. RESULTS: A total of 624 patients were included in the study. Those receiving anticoagulation therapy (n=425; 68%) more frequently had hypertension, diabetes and previous embolism as well as a greater number of cardioembolic risk factors (P< .001). Overall, 93% of non-anticoagulated patients received platelet aggregation inhibitors (92% received aspirin). After a median follow-up of 21 months, the probability of an embolic event was lower in anticoagulated patients (0.81% vs 14.04%; P< .001), as was all-cause mortality (3.27% vs 6.42%; P=.003). However, there was no significant difference in the probability of severe bleeding (2.75% vs 2.93%; P=.96). Results were unchanged after adjustment for age, sex, and previous embolic events. CONCLUSIONS: Oral anticoagulation therapy for nonvalvular atrial fibrillation implemented according to scientific associations' recommendations is effective and safe in daily clinical practice.

Nutritional Intervention in Malnourished Hospitalized Patients with Heart Failure.

BACKGROUND AND AIMS: Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. We undertook this study to assess whether a nutritional intervention in malnourished hospitalized patients with heart failure benefits morbidity and mortality. METHODS: A multicenter, randomized, controlled clinical trial was conducted. A total of 120 malnourished hospitalized patients due to acute heart failure were randomised to conventional heart failure treatment or conventional heart failure treatment combined with an individualized nutritional intervention. The primary endpoint of this study was a composite of all-cause death or readmission for worsening of HF, with a maximum follow-up of 12 months. Analysis was by intention to treat. RESULTS: Recruitment was stopped early according to the study protocol after completing the follow-up of the first 120 patients enrolled (59 in the intervention group and 61 in the control group). Both groups were homogeneous in baseline characteristics. At 12 months, the primary outcome occurred in 27.1% of patients in the intervention group and in 60.7% of patients in the control group (hazard ratio 0.45; 95% confidence interval [CI], 0.19-0.62, p = 0.0004). In total, 20.3% of patients died in the intervention group and 47.5% in the control group (hazard ratio 0.37, 95% CI, 0.19-0.72, p = 0.003). Readmission due to heart failure was also lower in the intervention group (10.2 vs. 36.1%, p = 0.001). CONCLUSION: Nutritional intervention in malnourished hospitalized patients with heart failure reduces the risk of death from any cause and the risk of readmission for worsening of heart failure (ClinicalTrial.govNCT01472237).

[Short- and long-term prognosis of infective endocarditis in non-injection drug users: improved results over 15 years (1987-2001)]. / Pronóstico a corto y largo plazo de la endocarditis infecciosa en pacientes no usuarios de drogas por vía parenteral. Resultados durante un período de 15 años (1987-2001).

INTRODUCTION AND OBJECTIVES: The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users. PATIENTS AND METHOD: We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers. RESULTS: Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase. CONCLUSIONS: Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals.

Rationale and design of PICNIC study: nutritional intervention program in hospitalized patients with heart failure who are malnourished.

INTRODUCTION AND OBJECTIVES: Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. It is unknown whether a nutritional intervention can modify the prognosis of these patients. The aim of this study is to assess the efficacy of a nutritional intervention on morbidity and mortality in hospitalized patients with heart failure who are malnourished. METHODS: PICNIC is a multicentre, randomized, controlled trial in which hospitalized patients with heart failure and malnutrition, as defined by the Mini Nutritional Assessment, are randomly assigned to conventional management of heart failure or conventional management of heart failure and an individualized nutritional intervention consisting of 3 points: optimization of diet, specific recommendations, and prescription, if deemed necessary, of nutritional supplements. A sample size of 182 patients for a maximum follow-up of 12 months has been estimated. The primary endpoint is time to death from any cause or rehospitalization because of heart failure. Analysis is by intention to treat. CONCLUSIONS: PICNIC study will determine the prognostic impact of a nutritional intervention in hospitalized patients with heart failure who are malnourished.

Seguimiento mediante programas específicos de consulta precoz tras el alta de un episodio de insuficiencia cardiaca: ¿en todos los pacientes? / Do all patients with heart failure benefit from a program for early follow-up after hospital discharge?

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[Impact of malnutrition on long-term mortality in hospitalized patients with heart failure]. / Influencia de la desnutrición en la mortalidad a largo plazo de pacientes hospitalizados por insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: The prevalence of malnutrition among patients with heart failure and the role it might play in prognosis is not currently known. The aim of this study was to analyse the prevalence and risk of malnutrition as well as its possible influence on long-term mortality in patients with heart failure. METHODS: A prospective analysis was conducted on 208 patients discharged consecutively from our centre between January 2007 and March 2008 after being hospitalised with heart failure. Before discharge, a complete nutritional assessment was performed and diagnosis of malnutrition and risk of malnutrition was done with the Mini Nutritional Assessment. Its possible independent association with mortality was assessed by a Cox multivariate analysis. RESULTS: The mean age of the patients was 73 ± 10 years, with 46% women; the most common aetiology of heart failure was ischaemia (41%). In addition, 13% were classified as malnourished, 59.5% at risk of malnutrition and 27.5% were well-nourished. At a median follow-up of 25 months, mortality in the three groups was 76%, 35.9% and 18.9%, respectively (log-rank, P<.001). In the Cox multivariate analysis, the malnutrition state was an independent predictor of mortality (hazard ratio 3.75, 95% confidence interval, 1.75-8.02, P=.001). CONCLUSIONS: Malnutrition and the risk of malnutrition are highly prevalent in patients hospitalised for heart failure. Furthermore, we found that the state of malnutrition as defined by the Mini Nutritional Assessment survey is an independent predictor of mortality in these patients.

Justificación y diseño del estudio PICNIC: Programa de Intervención Nutricional en pacientes hospitalizados por Insuficiencia Cardiaca desnutridos / Rationale and Design of PICNIC Study: Nutritional Intervention Program in Hospitalized Patients With Heart Failure Who Are Malnourished

Introducción y objetivos: Los pacientes hospitalizados por insuficiencia cardiaca en estado de desnutrición tienen un pronóstico más desfavorable que los que están en adecuado estado nutricional. Se desconoce si una intervención nutricional puede modificar el pronóstico de estos pacientes. El objetivo de este estudio es evaluar si una intervención nutricional sobre pacientes hospitalizados con insuficiencia cardiaca desnutridos produce beneficio en su morbimortalidad. Métodos: PICNIC es un ensayo clínico multicéntrico, aleatorizado y controlado, en el que se asigna aleatoriamente a los pacientes hospitalizados por insuficiencia cardiaca aguda que además estén en estado de desnutrición, definido según la puntuación de la encuesta Mini Nutritional Assessment, a tratamiento convencional de la insuficiencia cardiaca o a tratamiento convencional de la insuficiencia cardiaca más una intervención nutricional individualizada que consta de tres puntos: optimización de la dieta, recomendaciones específicas y prescripción, si se estima necesario, de suplementos nutricionales. Se ha estimado un tamaño muestral de 182 pacientes para un periodo máximo de seguimiento de 12 meses. La variable principal del estudio será el tiempo hasta la muerte por cualquier causa o reingreso por insuficiencia cardiaca. El análisis se realiza por intención de tratar. Conclusiones: El estudio PICNIC determinará el impacto pronóstico de una intervención nutricional en pacientes hospitalizados con insuficiencia cardiaca desnutridos (AU)

Introduction and objectives: Hospitalized patients with heart failure who are malnourished present a worse prognosis than those with an adequate nutritional status. It is unknown whether a nutritional intervention can modify the prognosis of these patients. The aim of this study is to assess the efficacy of a nutritional intervention on morbidity and mortality in hospitalized patients with heart failure who are malnourished. Methods: PICNIC is a multicentre, randomized, controlled trial in which hospitalized patients with heart failure and malnutrition, as defined by the Mini Nutritional Assessment, are randomly assigned to conventional management of heart failure or conventional management of heart failure and an individualized nutritional intervention consisting of 3 points: optimization of diet, specific recommendations, and prescription, if deemed necessary, of nutritional supplements. A sample size of 182 patients for a maximum follow-up of 12 months has been estimated. The primary endpoint is time to death from any cause or rehospitalization because of heart failure. Analysis is by intention to treat. Conclusions: PICNIC study will determine the prognostic impact of a nutritional intervention in hospitalized patients with heart failure who are malnourished (AU)

Desnutrición e insuficiencia cardiaca. Apostillas / Malnutrition and Heart Failure: comments

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Influencia de la desnutrición en la mortalidad a largo plazo de pacientes hospitalizados por insuficiencia cardiaca / Impact of malnutrition on long-term mortality in hospitalized patients with heart failure

Introducción y objetivos. Actualmente se desconoce la prevalencia de desnutrición entre los pacientes con insuficiencia cardiaca y el papel que este estado pudiera tener en su pronóstico. El objetivo de este estudio es analizar la prevalencia y riesgo de desnutrición y su posible influencia en la mortalidad a largo plazo de los pacientes con insuficiencia cardiaca. Métodos. Se analizó prospectivamente a 208 pacientes dados de alta consecutivamente desde nuestro centro entre enero de 2007 y marzo de 2008 tras un ingreso por insuficiencia cardiaca. Antes del alta, se realizó una completa valoración nutricional y se realizó el diagnóstico de desnutrición y riesgo de desnutrición mediante la encuesta Mini Nutritional Assessment. Su posible asociación independiente con la mortalidad se valoró mediante un análisis multivariable de Cox. Resultados. La media de edad fue 73±10 años, el 46% eran mujeres y la etiología más frecuente de la insuficiencia cardiaca fue la isquémica (41%). El 13% de los pacientes fueron clasificados como desnutridos; el 59,5%, en riesgo de desnutrición y el 27,5%, bien nutridos. A los 25 meses (mediana de seguimiento), la mortalidad en los tres grupos fue del 76, el 35,9 y el 18,9% respectivamente (log-rank test, p<0,001). En el análisis multivariable de Cox, el estado de desnutrición resultó ser un predictor independiente de mortalidad (hazard ratio=3,75; intervalo de confianza del 95%, 1,75-8,02; p=0,001). Conclusiones. La desnutrición y el de riesgo de desnutrición alcanzan una prevalencia elevada en pacientes hospitalizados por insuficiencia cardiaca. Además, hemos encontrado que el estado de desnutrición definido mediante el Mini Nutritional Assessment es un predictor independiente de mortalidad en estos pacientes (AU)

Introduction and objectives. The prevalence of malnutrition among patients with heart failure and the role it might play in prognosis is not currently known. The aim of this study was to analyse the prevalence and risk of malnutrition as well as its possible influence on long-term mortality in patients with heart failure. Methods. A prospective analysis was conducted on 208 patients discharged consecutively from our centre between January 2007 and March 2008 after being hospitalised with heart failure. Before discharge, a complete nutritional assessment was performed and diagnosis of malnutrition and risk of malnutrition was done with the Mini Nutritional Assessment. Its possible independent association with mortality was assessed by a Cox multivariate analysis. Results. The mean age of the patients was 73±10 years, with 46% women; the most common aetiology of heart failure was ischaemia (41%). In addition, 13% were classified as malnourished, 59.5% at risk of malnutrition and 27.5% were well-nourished. At a median follow-up of 25 months, mortality in the three groups was 76%, 35.9% and 18.9%, respectively (log-rank, P<.001). In the Cox multivariate analysis, the malnutrition state was an independent predictor of mortality (hazard ratio 3.75, 95% confidence interval, 1.75-8.02, P=.001). Conclusions. Malnutrition and the risk of malnutrition are highly prevalent in patients hospitalised for heart failure. Furthermore, we found that the state of malnutrition as defined by the Mini Nutritional Assessment survey is an independent predictor of mortality in these patients (AU)

Anticoagulación oral en la fibrilación auricular no valvular: ¿son efectivas y seguras las recomendaciones científicas en la práctica clínica diaria? / Oral anticoagulation for nonvalvular atrial fibrillation: are scientific recommendations effective and safe in daily clinical practice?

Introducción y objetivos. Estudiar la efectividad y la seguridad de un protocolo prospectivo de anticoagulación en la fibrilación auricular no valvular, basado en las recomendaciones de las sociedades científicas, en pacientes no seleccionados de la práctica clínica diaria. Métodos. Todos los pacientes consecutivos con fibrilación auricular permanente atendidos del 1 de febrero de 2000 al 1 de febrero de 2002 en 2 consultas ambulatorias de cardiología fueron incluidos en un protocolo de anticoagulación basado en las guías de la Sociedad Española de Cardiología y del American College of Cardiology/American Heart Association/European Society of Cardiology, y seguidos prospectivamente para eventos mayores (muerte, ictus, accidente isquémico transitorio, embolias periféricas o hemorragia severa) por grupo de tratamiento. Resultados. Se incluyó en el estudio a un total de 624 pacientes. Los pacientes anticoagulados (n = 425; 68%) presentaron una mayor frecuencia de hipertensión, diabetes y embolia previa, así como un mayor número de factores de riesgo cardioembólicos (p < 0,001). El 93% de los pacientes no anticoagulados recibió antiagregantes (el 92%, aspirina). Tras un seguimiento (mediana) de 21 meses, las probabilidades de eventos embólicos (el 0,81 frente al 14,04%; p < 0,001) y de mortalidad (el 3,27 frente al 6,42%; p = 0,003) fueron menores en los pacientes anticoagulados, sin una diferencia significativa en la probabilidad de sangrado severo (el 2,75 frente al 2,93%; p = 0,96). Los resultados fueron consistentes tras ajustar por edad, sexo y embolias previas. Conclusiones. La anticoagulación oral en la fibrilación auricular no valvular siguiendo las recomendaciones de las sociedades científicas es efectiva y segura en la práctica clínica diaria

Introduction and objectives. To study the efficacy and safety of an oral anticoagulation protocol for the treatment of nonvalvular atrial fibrillation, based on scientific associations' recommendations, in unselected patients seen in daily clinical practice. Methods. The study included all consecutive patients with permanent nonvalvular atrial fibrillation who attended two outpatient cardiology clinics between February 1, 2000 and February 1, 2002. They were treated according to an anticoagulation protocol based on Spanish Society of Cardiology and American College of Cardiology/American Heart Association/European Society of Cardiology guidelines. Patients were followed up prospectively for major events, such as death, stroke, transient ischemic attack, peripheral embolism and severe hemorrhage, which were recorded by treatment group. Results. A total of 624 patients were included in the study. Those receiving anticoagulation therapy (n=425; 68%) more frequently had hypertension, diabetes and previous embolism as well as a greater number of cardioembolic risk factors (P<.001). Overall, 93% of non-anticoagulated patients received platelet aggregation inhibitors (92% received aspirin). After a median follow-up of 21 months, the probability of an embolic event was lower in anticoagulated patients (0.81% vs 14.04%; P<.001), as was all-cause mortality (3.27% vs 6.42%; P=.003). However, there was no significant difference in the probability of severe bleeding (2.75% vs 2.93%; P=.96). Results were unchanged after adjustment for age, sex, and previous embolic events. Conclusions. Oral anticoagulation therapy for nonvalvular atrial fibrillation implemented according to scientific associations' recommendations is effective and safe in daily clinical practice

¿Se deben mantener los inhibidores de la enzima de conversión de la angiotensina a largo plazo en pacientes que normalizan la fracción de eyección tras un episodio de miocarditis aguda? / Should angiotensin-converting enzyme inhibitors be continued over the long term in patients whose left ventricular ejection fraction normalizes after an episode of acute myocarditis?

El efecto favorable de la administración de los inhibidores de la enzima de conversión de la angiotensina (IECA) a largo plazo en pacientes con insuficiencia cardiaca crónica y fracción de eyección deprimida está bien establecido, pero no hay tanta evidencia en pacientes con disfunción sistólica secundaria a miocarditis aguda que normalizan la contracción ventricular. Hemos seguido a 35 pacientes con miocarditis aguda y fracción de eyección 50% en los 35 casos. De esos 35, en 15 se suspendieron los IECA, mientras que 20 continuaron tomándolos. A los 3 años de seguimiento no hubo ninguna muerte, pero los pacientes en los que se suspendieron los IECA tuvieron una mayor incidencia de nuevos episodios de insuficiencia cardiaca con fracción de eyección < 45% (el 33 frente al 5%; p = 0,064) y menor fracción de eyección (47 ± 12 frente a 57 ± 11%; p = 0,002), lo que indica que estos fármacos se deben mantener a largo plazo también en estos pacientes

It is well established that long-term administration of angiotensin-converting enzyme (ACE) inhibitors has a favorable effect in patients with chronic heart failure and dilated cardiomyopathy. However, less information is available on patients whose left ventricular ejection fraction normalizes after an episode of systolic dysfunction secondary to acute myocarditis. We followed 35 patients who were diagnosed at our center between 1987 and 1995 with acute myocarditis and an ejection fraction 50% in all 35 patients. Treatment with ACE inhibitors was discontinued in 15 of the 35 patients, while the other 20 continued ACE inhibitor therapy. After 3 years of follow-up, no death had occurred, but the incidence of new episodes of heart failure with a left ventricular ejection fraction <45% was higher in patients who stopped taking ACE inhibitors (33% vs 5%, P=.064), and their ejection fraction was lower (47 [12%] vs 57 [11%], P=.002). These results suggest that ACE inhibitors should be continued over the long term in these patients

Pronóstico a corto y largo plazo de la endocarditis infecciosa en pacientes no usuarios de drogas por vía parenteral. Resultados durante un período de 15 años (1987-2001) / Short- and long-term prognosis of infective endocarditis in non-injection drug users: improved results over 15 years (1987-­2001)

Introducción y objetivos. La endocarditis infecciosa ha experimentado cambios importantes en los últimos años. El objetivo de nuestro trabajo es estudiar las características clínicas y el pronóstico a corto y largo plazo de la endocarditis infecciosa en pacientes no usuarios de drogas por vía parenteral. Pacientes y método. Hemos analizado 222 casos diagnosticados consecutivamente en nuestros centros desde 1987 hasta junio de 2001. Resultados. La edad media fue de 48 ± 19 años y 145 pacientes (65%) eran varones. En 154 casos se trataba de una endocarditis nativa (69%) y en 68 (31%) de una endocarditis protésica. En 61 pacientes (27%) no había cardiopatía predisponente. Los gérmenes causales más frecuentes fueron estafilococos (81 casos; 37%) y estreptococos (78 casos; 35%). Un 48% de los casos (107 pacientes) precisó cirugía durante la fase activa de la enfermedad. La mortalidad hospitalaria global fue del 17% (39 casos) y se redujo de forma significativa en los años más recientes (el 25% en 1989-1995 frente al 12% en 1996-2001; p < 0,01). La tasa de cirugía precoz electiva aumentó del 22% en 1989-1995 al 32% en 1996-2001 (p < 0,05). Tras un seguimiento de 60 ± 48 meses, 15 pacientes (8%) necesitaron cirugía tardía y 18 (10%) murieron. La supervivencia global a los 6 años fue del 72% y la de los pacientes que habían sobrevivido a la fase activa de la enfermedad del 80%. Conclusiones. El pronóstico a corto y largo plazo de los pacientes con endocarditis infecciosa parece estar mejorando en nuestro medio en los últimos años, en comparación con el de épocas más antiguas

Introduction and objectives. The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users. Patients and method. We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers. Results. Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase. Conclusions. Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals