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Talha KM, Dayer MJ, Thornhill MH, Tariq W, Arshad V, Tleyjeh IM, Bailey KR, Palraj R, Anavekar NS, Rizwan Sohail M, DeSimone DC, Baddour LM. Temporal Trends of Infective Endocarditis in North America From 2000 to 2017-A Systematic Review. Open Forum Infect Dis 2021; 8:ofab479. [PMID: 35224128 PMCID: PMC8864733 DOI: 10.1093/ofid/ofab479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 01/01/2023] Open
Abstract
Background The objective of this paper was to examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America. Methods A systematic review was conducted at Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science were searched for studies published between January 1, 2000, and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included. Results Of 8588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for 2 studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7% to 14.4%, while the percentage of patients who underwent surgery ranged from 6.4% to 16.0%. Conclusions The overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations has been highlighted for use in subsequent systematic reviews of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, UK
| | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Division of Epidemiology, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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Tan C, Hansen M, Cohen G, Boyle K, Daneman N, Adhikari NKJ. Accuracy of administrative data for identification of patients with infective endocarditis. Int J Cardiol 2016; 224:162-164. [PMID: 27657467 DOI: 10.1016/j.ijcard.2016.09.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/26/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infective endocarditis is associated with high morbidity and mortality rates that have plateaued over recent decades. Research to improve outcomes for these patients is limited by the rarity of this condition. Therefore, we sought to validate administrative database codes for the diagnosis of infective endocarditis. METHODS We conducted a retrospective validation study of International Classification of Diseases (ICD-10-CM) codes for infective endocarditis against clinical Duke criteria (definite and probable) at a large acute care hospital between October 1, 2013 and June 30, 2015. To identify potential cases missed by ICD-10-CM codes, we also screened the hospital's valvular heart surgery database and the microbiology laboratory database (the latter for patients with bacteremia due to organisms commonly causing endocarditis). RESULTS Using definite Duke criteria or probable criteria with clinical suspicion as the reference standard, the ICD-10-CM codes had a sensitivity (SN) of 0.90 (95% confidence interval (CI), 0.81-0.95), specificity (SP) of 1 (95% CI, 1-1), positive predictive value (PPV) of 0.78 (95% CI, 0.68-0.85) and negative predictive value (NPV) of 1 (95% CI, 1-1). Restricting the case definition to definite Duke criteria resulted in an increase in SN to 0.95 (95% CI, 0.86-0.99) and a decrease in PPV to 0.6 (95% CI, 0.49-0.69), with no change in specificity. CONCLUSION ICD-10-CM codes can accurately identify patients with infective endocarditis, and so administrative databases offer a potential means to study this infection over large jurisdictions, and thereby improve the prediction, diagnosis, treatment and prevention of this rare but serious infection.
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Affiliation(s)
- Charlie Tan
- Sunnybrook Research Institute, Toronto, Canada
| | - Mark Hansen
- Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Gideon Cohen
- Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Karl Boyle
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Nick Daneman
- Sunnybrook Research Institute, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Neill K J Adhikari
- Sunnybrook Research Institute, Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
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Merkler AE, Chu SY, Lerario MP, Navi BB, Kamel H. Temporal relationship between infective endocarditis and stroke. Neurology 2015; 85:512-6. [PMID: 26163428 DOI: 10.1212/wnl.0000000000001835] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/08/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Stroke frequently complicates infective endocarditis (IE). However, the temporal relationship between these diseases is uncertain. METHODS We performed a retrospective study of adult patients hospitalized for IE between July 1, 2007, and June 30, 2011, at nonfederal acute care hospitals in California. Previously validated diagnosis codes were used to identify the primary composite outcome of ischemic or hemorrhagic stroke during discrete 1-month periods from 6 months before to 6 months after the diagnosis of IE. The odds of stroke in these periods were compared with the odds of stroke in the corresponding 1-month period 2 years earlier, which was considered the baseline risk of stroke. RESULTS Among 17,926 patients with IE, 2,275 strokes occurred within the 12-month period surrounding the diagnosis of IE. The risk of stroke was highest in the month after diagnosis of IE (1,640 vs 17 strokes in the corresponding month 2 years prior). This equaled an absolute risk increase of 9.1% (95% confidence interval 8.6%-9.5%) and an odds ratio of 96.5 (95% confidence interval 60.1-166.0). Stroke risk was significantly increased beginning 4 months before the diagnosis of IE and lasting 5 months afterward. Similar temporal patterns were seen when ischemic and hemorrhagic strokes were considered separately. CONCLUSIONS The association between IE and stroke persists for longer than previously reported. Most diagnoses of stroke and IE are made close together in time, but a period of heightened stroke risk becomes apparent several months before the diagnosis of IE and lasts for several months afterward.
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Affiliation(s)
- Alexander E Merkler
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT.
| | - Stacy Y Chu
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
| | - Michael P Lerario
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
| | - Babak B Navi
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
| | - Hooman Kamel
- From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT
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Bikdeli B, Wang Y, Kim N, Desai MM, Quagliarello V, Krumholz HM. Trends in hospitalization rates and outcomes of endocarditis among Medicare beneficiaries. J Am Coll Cardiol 2013; 62:2217-26. [PMID: 23994421 DOI: 10.1016/j.jacc.2013.07.071] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine the hospitalization rates and outcomes of endocarditis among older adults. BACKGROUND Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. METHODS Using Medicare inpatient Standard Analytic Files, we identified all fee-for-service beneficiaries age ≥65 years with a principal or secondary diagnosis of endocarditis from 1999 to 2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised their recommendations for endocarditis prophylaxis. RESULTS Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999 to 2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006 to 2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with a principal diagnosis of endocarditis. CONCLUSIONS Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines.
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Affiliation(s)
- Behnood Bikdeli
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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