Sami El-Dalati1, Daniel Cronin2, James Riddell3, Michael Shea4, Richard L Weinberg4, Laraine Washer3, Emily Stoneman3, D Alexander Perry3, Suzanne Bradley3, James Burke5, Sadhana Murali5, Christopher Fagan6, Rishi Chanderraj3, Paul Christine6, Twisha Patel7, Kirra Ressler8, Shinichi Fukuhara8, Matthew Romano8, Bo Yang8, George Michael Deeb8. 1. Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan. Electronic address: seldalat@med.umich.edu. 2. Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan. 3. Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan. 4. Department of Internal Medicine, Division of Cardiology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan. 5. Department of Neurology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan. 6. Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan. 7. College of Pharmacy, Michigan Medicine - University of Michigan, Ann Arbor, Michigan. 8. Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Infectious endocarditis is associated with substantial in-hospital mortality of 15%-20%. Effective management requires coordination between multiple medical and surgical subspecialties, which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality. METHODS: The multidisciplinary endocarditis team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching. RESULTS: Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria-definite endocarditis and at least 1 American Heart Association indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1, 2014, and June 30, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (P < .0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; P = 0.12). Propensity score matching demonstrated similar results. CONCLUSIONS: Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the 2 studied cohorts. In conjunction with previous studies demonstrating their effectiveness, these data support the idea that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.
BACKGROUND: Infectious endocarditis is associated with substantial in-hospital mortality of 15%-20%. Effective management requires coordination between multiple medical and surgical subspecialties, which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality. METHODS: The multidisciplinary endocarditis team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching. RESULTS: Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria-definite endocarditis and at least 1 American Heart Association indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1, 2014, and June 30, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (P < .0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; P = 0.12). Propensity score matching demonstrated similar results. CONCLUSIONS: Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the 2 studied cohorts. In conjunction with previous studies demonstrating their effectiveness, these data support the idea that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.
Authors: Juan Caceres; Aroosa Malik; Tom Ren; Aroma Naeem; Jeffrey Clemence; Alexander Makkinejad; Xiaoting Wu; Bo Yang Journal: JTCVS Open Date: 2022-05-31
Authors: Sami El-Dalati; Daniel Cronin; James Riddell; Michael Shea; Richard L Weinberg; Emily Stoneman; Twisha Patel; Kirra Ressler; George Michael Deeb Journal: Ther Adv Infect Dis Date: 2021-12-16