The influence of race in older adults with infective endocarditis.

BACKGROUND: Age is a risk factor for infective endocarditis, and almost half of diagnosed patients are age ≥ 60 years. Large national studies have not evaluated inpatient mortality and surgical valvular interventions between older White and Black patients hospitalized with infective endocarditis. METHODS: We used the Nationwide Inpatient Sample database to identify older adults ≥60 years in North America with a principle diagnosis of infective endocarditis. Multivariate logistic regression was used to compare in-hospital mortality and valvular repairs/replacement between older Black and White patients. RESULTS: Of 10,390 adults, age ≥ 60 years hospitalized for infective endocarditis during 2013 and 2014, 7356 were White and 1089 Black. Blacks were younger (mean age: 70.5 ± 0.5 vs. 73.5 ± 0.2 years, p < 0.01), lived in more zip codes with a median annual income <$39,000/yr. (40.4% vs 18.8%, p < 0.01), and had higher co-morbidity burden (Charlson comorbidity score ≥ 3: 54.6% vs 40.7%, p < 0.01). After multivariate adjustment, Blacks had higher odds for in-hospital mortality (Odds Ratio (OR) = 2.0, [Confidence Interval (CI) 1.1-3.8]; p = 0.020), and lower odds for mitral valve repairs/replacements (OR = 0.53, CI: 0.29-0.99, p = 0.049). CONCLUSIONS: Blacks age ≥ 60 years hospitalized in North America with infective endocarditis are less likely to undergo mitral valvular repairs/replacement and had higher in-hospital mortality compared to White patients.

Morbidity and mortality of infective endocarditis in a hospital system in New York City serving a diverse urban population.

Infective endocarditis (IE) is a severe illness associated with significant morbidity and mortality. The primary purpose of this study was to evaluate morbidity and mortality of IE in a hospital serving the most diverse area in New York City. An analysis of 209 patients admitted to the hospital from 2000 to 2012 who were found to have IE based on modified Duke criteria. Among the 209 patients with IE, 188 (88.8%) had native heart valves and 21 (11.2%) had prosthetic valves. Of the patients with native heart valves, 3.7% had coronary artery bypass graft, 4.3% were active drug users, 6.3% had permanent pacemakers, 12.2% had a history of IE, 25.7% were diabetic, 17% had end-stage renal disease (ESRD), 9% had congestive heart failure, 8% had abnormal heart valves, and 13.8% had an unknown etiology. Mortality rates of the patients with prosthetic heart valves were 27.7% compared to 8.11% in patients with native heart valves (OR 3, p<0.0001). Since we identified diabetes mellitus and ESRD to be significant risk factors in our population, we isolated and compared characteristics of patients with and without IE. IE among patients with diabetes mellitus was 23% compared with 13.8% in the control group (p=0.016). Cases of IE in patients with ESRD were 15.3%, compared with 4% in the control group (p<0.0001). We identified an overall mortality rate of 20.1% in patients with IE, a readmission rate within 30 days of discharge of 21.5%, and an average age of 59 years. Among 209 patients, 107 were males and 102 females. The most common organisms identified were Staphylococcus aureus (43.7%), viridans streptococci (17%) followed by Enterococcus (14.7%). Despite appropriate treatment, high rates of morbidity and mortality remained, with a higher impact in patients greater than 50 years of age. Such discoveries raise the importance of controlling and monitoring risk factors for IE.

Oral health of patients with severe rheumatic heart disease.

In order to determine whether adequate attention is paid to the maintenance of good oral health in patients at risk of developing infective endocarditis, we studied 44 black patients with severe rheumatic heart disease before they had cardiac surgery. Plaque and gingival index scores were calculated and panoramic radiographs were done in all patients. There were 17 males and 27 females (mean age: 30.6 years). The plaque and gingival index scores were classified as poor in 31.8 and 54.6% of patients, respectively. Panoramic radiographic findings included caries in 56.8% of patients, peri-apical pathology in 18.1% and retained roots in 22.7% of patients. This study demonstrates that inadequate attention is paid to the maintenance of good oral health in patients with severe rheumatic heart disease. The oral and dental care of patients at risk of developing infective endocarditis needs to be improved.

Isolated right-sided endocarditis in Hong Kong Chinese.

Thirteen histologically-proven cases of endocarditis confined to the right side of the heart were found in 9406 consecutive autopsies. Eleven cases involved the tricuspid valve and two the atrial endocardium. Nine cases were in males and 4 in females. Only one case showed underlying valvular/endocardial disease. Eight cases were infective, with Staphylococcus aureus being the predominant organism, and 5 non-infective. For the infective cases, intravenous drug abuse was the commonest predisposing factor, and malignancy the commonest association for the non-infective. The commonest overall complication was lung abscess due to septic emboli in the 3 drug addicts, a common association in other reported series. These latter cases are particularly important to recognize, being generally more responsive to treatment than left-sided infective endocarditis.

Nonbacterial thrombotic endocarditis in Hong Kong Chinese.

Fifty-two Hong Kong Chinese cases of nonbacterial thrombotic endocarditis at autopsy were reviewed to ascertain if there was any difference in autopsy incidence, associated diseases, age and sex incidence, distribution of infarcts, and pattern of valve involvement compared with that in previously reported series. The overall autopsy incidence was 0.68%, within the range of previous reports. Forty-one cases (79%) were associated with malignant neoplasms; the remaining 11 cases were associated with miscellaneous disorders. Adenocarcinoma was associated with 27 (52%) of the cases. Unusual findings were the association of five cases with intrahepatic cholangiocarcinoma and four cases with esophageal squamous carcinoma. This is explicable on the basis of a higher incidence of these two tumors in Hong Kong Chinese than in Western populations, ie, the source of most other reported series. Sex and age incidence, the distribution of infarcts, and the pattern of valve involvement were similar to those reported in other series of nonbacterial thrombotic endocarditis.