Boaz Elad1, Leor Perl2,3, Ashraf Hamdan2,3, Dafna Yahav4,3, Alaa Atamna4,3, Hila Shaked4,3, Victor Rubchevsky5,3, Ram Sharony5,3, Hanna Bernstine6,3, Yaron Shapira2,3, Mordehay Vaturi2,3, Hadas Ofek2,3, Alexander Sagie2,3, Ran Kornowski2,3, Katia Orvin7,8. 1. Department of Cardiology, Rambam Health Care Campus, Haifa, Israel. 2. Cardiology Department, Rabin Medical Center, 39 Jabotinsky St. 49100, Petach Tikva, Israel. 3. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Infectious Diseases Unit, Rabin Medical Center, Petach Tikva, Israel. 5. Cardiothoracic Surgery, Rabin Medical Center, Petach Tikva, Israel. 6. Nuclear Medicine Department, Rabin Medical Center, Petach Tikva, Israel. 7. Cardiology Department, Rabin Medical Center, 39 Jabotinsky St. 49100, Petach Tikva, Israel. katiaorvin@gmail.com. 8. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. katiaorvin@gmail.com.
Abstract
PURPOSE: To evaluate the impact of a multidisciplinary the "Endocarditis Team" (ET) on the course and outcome of infective endocarditis (IE) patients. METHODS: A retrospective before-after study, including hospitalized patients with definite IE, managed before (01.2013-12.2015) and after (01.2016-07.2019) the introduction of an ET. The primary outcomes were defined as 30-day and 1-year mortality and the secondary as conservative vs. invasive strategy, the interval from clinical suspicion of IE to the performance of echocardiography, utilization of multimodality evaluation, time to an invasive procedure, and the duration of hospitalization. RESULTS: Study population included 92 pre-ET and 128 post-ET implementation patients. Baseline characteristics were similar. During the post-ET period compared with pre-ET, we found higher rates of abscesses and extra-cardiac emboli (27.8% vs. 16.3%, p = 0.048); and a higher invasive procedures rate, including lead extraction (15.6% vs. 6.5%, p = 0.035) and noncardiac surgeries (14.8% vs. 6.5%, p = 0.05). Patients managed during the post-ET period had reduced short (8.5% vs. 17.4%, p = 0.048) and long-term mortality (Log-rank = 0.001). In multivariate analysis of risk factors for long-term mortality, period (pre- or post-ET) was not found to be significantly associated with the mortality. CONCLUSION: Establishment of an ET was associated with faster and more intensive evaluation of patients with IE. During the period of an ET activity, mortality rates were reduced compared with the previous period.
PURPOSE: To evaluate the impact of a multidisciplinary the "Endocarditis Team" (ET) on the course and outcome of infective endocarditis (IE) patients. METHODS: A retrospective before-after study, including hospitalized patients with definite IE, managed before (01.2013-12.2015) and after (01.2016-07.2019) the introduction of an ET. The primary outcomes were defined as 30-day and 1-year mortality and the secondary as conservative vs. invasive strategy, the interval from clinical suspicion of IE to the performance of echocardiography, utilization of multimodality evaluation, time to an invasive procedure, and the duration of hospitalization. RESULTS: Study population included 92 pre-ET and 128 post-ET implementation patients. Baseline characteristics were similar. During the post-ET period compared with pre-ET, we found higher rates of abscesses and extra-cardiac emboli (27.8% vs. 16.3%, p = 0.048); and a higher invasive procedures rate, including lead extraction (15.6% vs. 6.5%, p = 0.035) and noncardiac surgeries (14.8% vs. 6.5%, p = 0.05). Patients managed during the post-ET period had reduced short (8.5% vs. 17.4%, p = 0.048) and long-term mortality (Log-rank = 0.001). In multivariate analysis of risk factors for long-term mortality, period (pre- or post-ET) was not found to be significantly associated with the mortality. CONCLUSION: Establishment of an ET was associated with faster and more intensive evaluation of patients with IE. During the period of an ET activity, mortality rates were reduced compared with the previous period.
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