Surgical treatment for infective endocarditis in the ageing society: a nationwide retrospective study in Japan. Issue 1 (12th April 2021)

• Record Type: Journal Article
• Authors: Kiriyama, Hiroyuki; Kaneko, Hidehiro; Itoh, Hidetaka; Kamon, Tatsuya; Morita, Kojiro; Jo, Taisuke; Fujiu, Katsuhito; Daimon, Masao; Takeda, Norifumi; Morita, Hiroyuki; Yasunaga, Hideo; Komuro, Issei
• Is Part Of: Open heart. Volume 8:Issue 1(2021)
• Publication Date: 2021-04-12
• Subjects: endocarditis -- heart valve prosthesis implantation -- epidemiology; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2021-001627
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Objective: The current status of surgical treatment for infective endocarditis (IE) among very elderly people is unclear. Methods: We extracted data on patients in Japan with community-acquired IE who were admitted and discharged between April 2010 and February 2018 using a nationwide inpatient, the Diagnosis Procedure Combination database. We divided patients into three groups: non-elderly (<65 years), elderly (65–79 years) and very elderly (≥80 years). A 1:1 propensity score matching was performed to compare proportions of surgical treatment and in-hospital mortality among the groups. Results: We identified 20 667 eligible patients (median age 70 years, 61.0% men). The proportion of very elderly patients significantly increased (19.1% in 2010 to 29.7% in 2018). The proportion of surgical treatment was significantly lower, and in-hospital mortality was significantly higher in very elderly patients. This tendency was more pronounced among patients with in-hospital complications such as heart failure, stroke or embolism. Surgical treatment was significantly associated with lower in-hospital mortality even in very elderly patients, both in an unmatched (OR 0.61; 95% CI 0.47 to 0.78) and a propensity score matched cohort (OR 0.61; 95% CI 0.43 to 0.85). Conclusions: The proportion of very elderly patients with IE was increasing, and very elderly patients had higher in-hospital mortality. The proportion of surgical treatment for IE among very elderly patients was low, but it was associated with lower in-hospital mortality. Further studies are needed to establish the optimal strategy for IE among very elderly patients.