Infective endocarditis in a Finnish teaching hospital: a study on 326 episodes treated during 1980–2004

• Published in: Heart (British Cardiac Society) 2006-10, Vol.92 (10), p.1457-1462
• Main Authors: Heiro, M, Helenius, H, Mäkilä, S, Hohenthal, U, Savunen, T, Engblom, E, Nikoskelainen, J, Kotilainen, P
• Format: Article
• Language: English
• Subjects: Adult; Age; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Medicine; Endocardial and cardiac valvular diseases; Endocarditis, Bacterial - epidemiology; Endocarditis, Bacterial - therapy; Female; Finland; Heart; Heart Valve Diseases - epidemiology; Hospitalization - statistics & numerical data; Hospitalization - trends; Hospitals, Teaching; Humans; Infectious diseases; infective endocarditis; intravenous drug use; IVDU; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Microorganisms; Middle Aged; Prostheses; Recurrence; Renal Dialysis; Sex Distribution; Streptococcus infections; Substance Abuse, Intravenous - epidemiology; TOE; transoesophageal echocardiography; transthoracic echocardiography; TTE
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2005.084715

Objectives: To evaluate potential changes of infective endocarditis (IE) in patients treated in a Finnish teaching hospital during the past 25 years. Patients: 326 episodes of IE in 303 patients treated during 1980–2004 were evaluated for clinical characteristics and their changes over time. Results: The mean age of the patients increased with time (from 47.2 to 54.5 years, p  =  0.003). Twenty-five (7.7%) episodes were associated with intravenous drug use (IVDU), with a significant increase of these episodes after 1996 (from 0 to 19 (20%), p < 0.001). Viridans streptococci were the most common causative agents of IE during 1980–1994, but after that Staphylococcus aureus was the most common pathogen (p  =  0.015). The proportion of IE of the aortic valve decreased during the study (from 30 (49%) to 26 (27%), whereas the proportions of mitral (11 (18%) to 33 (35%) and tricuspid valve IE (0 to 13 (14%) increased correspondingly (p  =  0.001). This was mainly due to more patients with IVDU. Chronic dialysis for renal failure as an underlying condition increased over time (from 0 to 7 (7.4%), p  =  0.015) but no other predisposing conditions changed. Complications such as neurological manifestations and heart failure did not change in frequency, but the incidence of lung emboli increased (from 0% to 10.5%, p < 0.001); 83% of these emboli occurred in patients with IVDU. The proportion of patients requiring surgical treatment and mortality due to IE did not change. Conclusions: During these 25 years, the causative agents, affected valves and complications of IE changed to some degree. These changes were mainly attributed to the increase of IVDU-associated IE. Except for the increase in age, the clinical presentation and outcome in non-addicts remained substantially unchanged.