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Imazio M. The 2023 new European guidelines on infective endocarditis: main novelties and implications for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:01244665-990000000-00222. [PMID: 38916201 PMCID: PMC11365601 DOI: 10.2459/jcm.0000000000001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 06/26/2024]
Abstract
The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis update the previous 2015 guidelines with main novelties in five areas: (1) antibiotic prevention for high-risk patients, and prevention measures for intermediate-risk and high-risk patients; (2) diagnosis with emphasis on multimodality imaging to assess cardiac lesions of infective endocarditis' (3) antibiotic therapy allowing an outpatient antibiotic treatment for stabilized, uncomplicated cases; (4) cardiac surgery with an emphasis on early intervention without delay for complicated cases; and (5) shared management decision by the endocarditis team. Most evidence came from observational studies and expert opinions. The guidelines strongly support a patient-centred approach with a shared decision process by a multidisciplinary team that should be implemented either in tertiary referral centres, becoming heart valve centres, and referral centres. A continuous sharing of data is warranted in the hospitals' network between heart valve centres, which are used for referrals for complicated cases of infective endocarditis, and referral centres, which should be able to manage uncomplicated cases of infective endocarditis.
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Affiliation(s)
- Massimo Imazio
- Department of Medicine (DMED), University of Udine
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, ASUFC, Udine, Italy
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Wurcel AG, Zubiago J, Reyes J, Smyth E, Balsara KR, Avila D, Barocas JA, Beckwith CG, Bui J, Chastain CA, Eaton EF, Kimmel S, Paras ML, Schranz AJ, Vyas DA, Rapoport A. Surgeons' Perspectives on Valve Surgery in People With Drug Use-Associated Infective Endocarditis. Ann Thorac Surg 2023; 116:492-498. [PMID: 35108502 PMCID: PMC9339044 DOI: 10.1016/j.athoracsur.2021.12.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/01/2021] [Accepted: 12/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hospitalizations for drug-use associated infective endocarditis (DUA-IE) have led to increasing surgical consultation for valve replacement. Cardiothoracic surgeons' perspectives about the process of decision making around operation for people with DUA-IE are largely unknown. METHODS This multisite semiqualitative study sought to gather the perspectives of cardiothoracic surgeons on initial and repeat valve surgery for people with DUA-IE through purposeful sampling of surgeons at 7 hospitals: University of Alabama, Tufts Medical Center, Boston Medical Center, Massachusetts General Hospital, University of North Carolina-Chapel Hill, Vanderbilt University Medical Center, and Rhode Island Hospital-Brown University. RESULTS Nineteen cardiothoracic surgeons (53% acceptance) were interviewed. Perceptions of the drivers of addiction varied as well as approaches to repeat valve operations. There were mixed views on multidisciplinary meetings, although many surgeons expressed an interest in more efficient meetings and more intensive postoperative and posthospitalization multidisciplinary care. CONCLUSIONS Cardiothoracic surgeons are emotionally and professionally impacted by making decisions about whether to perform valve operation for people with DUA-IE. The use of efficient, agenda-based multidisciplinary care teams is an actionable solution to improve cross-disciplinary partnerships and outcomes for people with DUA-IE.
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Affiliation(s)
| | | | | | - Emma Smyth
- Tufts Medical Center, Boston, Massachusetts
| | - Keki R Balsara
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danielle Avila
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Joshua A Barocas
- Divisions of Internal Medicine and Infectious Diseases, University of Colorado, Denver, Colorado
| | - Curt G Beckwith
- Division of Infectious Diseases, Alpert Medical School of Brown University/The Miriam Hospital, Providence, Rhode Island
| | - Jenny Bui
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | | | - Ellen F Eaton
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Simeon Kimmel
- Section of General Internal Medicine/Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Molly L Paras
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Asher J Schranz
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Darshali A Vyas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Roy AS, Hagh-Doust H, Abdul Azim A, Caceres J, Denholm JT, Dong MQ(D, King M, Yen CF, Lee TC, McDonald EG. Multidisciplinary Teams for the Management of Infective Endocarditis: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad444. [PMID: 37674631 PMCID: PMC10478154 DOI: 10.1093/ofid/ofad444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Background The management of infective endocarditis (IE) is complex owing to a high burden of morbidity and mortality. Recent guidelines recommend dedicated multidisciplinary teams (MDTs) for the management of IE. The aim of this systematic review and meta-analysis was to evaluate and summarize the effect of MDT management on patient outcomes. Methods A systematic review was performed and, where feasible, results were meta-analyzed; otherwise, results were summarized narratively. Data extraction and quality assessment were performed in duplicate. Restricted maximum likelihood random effects models were used to calculate unadjusted risk ratios and 95% CIs. Results Screening of 2343 studies based on title and abstract yielded 60 full-text reviews; 18 studies were summarized narratively, of which 15 were included in a meta-analysis of short-term mortality. Meta-analysis resulted in a risk ratio of 0.61 (95% CI, .47-.78; I2 = 62%) for mortality in favor of a dedicated MDT as compared with usual care. Length of stay was variable, with 55% (10/18) of studies reporting an increased length of stay. Most studies (16/18, 88.9%) reported a decreased time to surgery and an increased rate of surgery (13/18, 73%). No studies reported on patient-reported outcomes. Conclusions This is the first systematic review and meta-analysis to assess the impact of MDT management on IE. The sum of evidence demonstrated a significant association between MDTs and improved short-term mortality. Further research is needed to evaluate benefits of virtual MDT care, cost-effectiveness, and the impact on patient-reported outcomes and long-term mortality.
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Affiliation(s)
- Anne-Sophie Roy
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Hamila Hagh-Doust
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Ahmed Abdul Azim
- Division of Infectious Diseases, Allergy and Immunology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Juan Caceres
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Justin T Denholm
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mei Qin (Denise) Dong
- Antimicrobial Stewardship Pharmacy, New York Health and Hospitals, Bellevue Hospital, New York City, New York, USA
| | - Madeline King
- Outpatient Antimicrobial Stewardship Clinical Pharmacy, Cooper University Healthcare, Camden, New Jersey, USA
| | - Christina F Yen
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Todd C Lee
- Clinical Practice Assessment Unit, McGill University Health Centre, Montreal, Canada
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, McGill University Health Centre, Montreal, Canada
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Canada
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Van Camp G, Beles M, Penicka M, Schelfaut D, Wouters S, De Raedt H, Wyffels E, Spapen J, Nasser R, Balogh Z, Albano M, De Beenhouwer H, Van Vaerenbergh K, Van Praet F, Degrieck I, Stockman B, Casselman F, Collet C. Importance of In-Hospital Prospective Registry and Infectious Endocarditis Heart Team to Monitor and Improve Quality of Care in Patients with Infectious Endocarditis. J Clin Med 2021; 10:jcm10173832. [PMID: 34501278 PMCID: PMC8432016 DOI: 10.3390/jcm10173832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE. Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced. Propensity score matching was used to assess the impact of an IEHT approach on clinical outcomes. Results: Median age was 72.5 y (62.75–80.00), diabetes was present in 33.1%, chronic kidney disease in 27.5%, COPD in 17.5%, and a history of ischaemic heart disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients. Staphylococcus (37.5%) was the most frequent pathogen followed by streptococcus (24.4%) and enterococcus (23.1%). Overall, 30-day and 1-year mortality were 19.4% and 37.5%, respectively. The introduction of prospective data collection and IE heart team was associated with a trend towards reduction of adjusted 1-year mortality (26.5% IEHT vs. 41.2% controls, p = 0.0699). An IEHT clinical decision-making approach was independently associated with a shorter length of stay (p = 0.04). Conclusions: Use of a prospective registry of IE coupled with a heart team approach was associated with more efficient patient management and a trend towards lower mortality. Prospective data collection and dedicated IEHT have the potential to improve patient care and clinical outcomes.
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Affiliation(s)
- Guy Van Camp
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
- Correspondence:
| | - Monika Beles
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Martin Penicka
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Dan Schelfaut
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Stijn Wouters
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Herbert De Raedt
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Eric Wyffels
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Jerrold Spapen
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Riwa Nasser
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
| | - Zsuzsanna Balogh
- Gottsegen Gyorgy National Institute of Cardilogy, Haller u. 29, 1096 Budapest, Hungary;
| | - Marzia Albano
- Cardiology Unit, S. Maria Nuova Hospital, Via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Hans De Beenhouwer
- Department of Microbiology, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (H.D.B.); (K.V.V.)
| | | | - Frank Van Praet
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Ivan Degrieck
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Bernard Stockman
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Filip Casselman
- Cardiovascular and Thoracic Surgery, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (F.V.P.); (I.D.); (B.S.); (F.C.)
| | - Carlos Collet
- Cardiovascular Center, OLV Aalst, Moorselbaan 164, 9300 Aalst, Belgium; (M.B.); (M.P.); (D.S.); (S.W.); (H.D.R.); (E.W.); (J.S.); (R.N.); (C.C.)
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Aldea GS. Commentary: Valve Surgery for Bacterial Endocarditis in Patients Who Use Intravenous Drugs a Societal Failure to Rescue. Semin Thorac Cardiovasc Surg 2021; 33:711-712. [PMID: 33607260 DOI: 10.1053/j.semtcvs.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
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Satriano UM, Nenna A, Spadaccio C, Pollari F, Fischlein T, Chello M, Nappi F. Guidelines on prosthetic heart valve management in infective endocarditis: a narrative review comparing American Heart Association/American College of Cardiology and European Society of Cardiology guidelines. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1625. [PMID: 33437824 PMCID: PMC7791243 DOI: 10.21037/atm-20-5134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Infective endocarditis (IE) represented over the last year a growing medical and surgical concern. The changes in etiology and demographic of the disease, which now includes also a large proportion of iatrogenic conditions, has prompted new studies and updates in the guideline for IE treatment. The increasing use of intravascular and intracardiac devices has introduced new challenges in terms of both antibiotic resistance and surgical treatment of prosthetic endocarditis. Also, patients with complex congenital heart diseases, intravenous drug abusers and patients with chronic renal failure under hemodialysis have been added to the list of high-risk subjects for IE. Important aspects concerning the establishment of the endocarditis team, the clinical management, the optimal medical therapy and the indication and timing for surgery are arguments of debate and controversy across the literature. In particular, the most adequate strategy to be adopted in the context of concomitant neurological complication remains greatly debated. Despite attempts to standardize the practice in IE, the lack of powered randomized clinical evidence prevented the achievement of a univocal consensus in several aspects of the management of IE. This situation reflects in some differences in the recommendation promoted by the European Society of Cardiology and American Heart Association/American College of Cardiology. In this review, we will compare the European Society of Cardiology and the American Heart Association guidelines and discuss important aspects related to clinical management and indications of for treatment.
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Affiliation(s)
| | - Antonio Nenna
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | | | - Massimo Chello
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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