Infective Endocarditis Outcomes in Congestive Heart Failure Patients

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Nov 13

PMID 39534831

Authors

Vivek Joseph Varughese

Chandler Richardson

Hata Mujadzic

Dominic Vacca

Prem Patel

Affiliations

Soon will be listed here.

Abstract

Background/objectives: The aim of this study is to analyze the difference in hospital outcomes for infective endocarditis (IE) admissions with and without comorbid congestive heart failure (CHF).

Methods: The National Inpatient Sample (NIS) was the database we used to find and sort patient data from inpatient hospitalizations. We then used logit probit regression to analyze the association between patients admitted for IE with and without CHF and their all-cause mortality rates. After collecting our sample population, we used propensity score matching to create our comparative cohorts of IE patients which were then analyzed to determine if there was an association between inpatient hospital outcomes and the presence of CHF.

Results: Among the patients admitted for IE, there was a statistically significant association between comorbid CHF diagnoses and an increase in all-cause mortality during hospital admission. The proportion of mortality was 7.8% during the hospitalization for IE admissions with comorbid CHF, while the proportion was 4.16% for the subset of IE admissions without comorbid CHF. The association of comorbid CHF and all-cause mortality during the hospital stay for IE admissions was significant with an odds ratio of 3.197 (2.089-4.891) after adjusting for age, sex, race, income, and other comorbidities. The association between the requirement for either temporary or continuous pacing during the hospital stay and co-existing CHF diagnosis in IE admissions was also significant with an odds ratio of 2.86 (1.720-4.761). Among the propensity-matched cohort analysis, there was a significantly higher proportion of IE admissions with co-existing CHF needing pacing (either temporary or continuous), 5.74% (3.96%-8.25%) compared to the IE cohort without comorbid CHF: 1.48% (0.71%-3.09%).

Conclusion: With the results of our analyses proving a significant association between the presence of CHF and adverse in-hospital outcomes in IE admissions, it calls for further prospective and real-world studies to analyze the finer aspects of the association. This becomes important for clinicians in stratifying at-risk patients for a higher level of care and prognostication aspects of the treatment. Our study results prove a causative association between the presence of CHF and heart block in IE admissions. This could be useful for clinicians in planning appropriate management plans in the event of initial signs of bradycardia and hypotension developing in this patient population.

References

Bramer G . International statistical classification of diseases and related health problems. Tenth revision. World Health Stat Q. 1988; 41(1):32-6. View

Jamal S, Kichloo A, Albosta M, Bailey B, Singh J, Wani F . In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample. J Investig Med. 2020; 69(2):358-363. DOI: 10.1136/jim-2020-001501. View

Patel M, Nesheiwat Z, Patel N, Soni R, Maaieh M . Triple Valve Endocarditis With Aortic Root Abscess Presenting With Complete Heart Block and Distal Embolization. Cureus. 2021; 13(3):e13942. PMC: 8051172. DOI: 10.7759/cureus.13942. View

Kiefer T, Park L, Tribouilloy C, Cortes C, Casillo R, Chu V . Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA. 2011; 306(20):2239-47. PMC: 5030065. DOI: 10.1001/jama.2011.1701. View

Slipczuk L, Codolosa J, Davila C, Romero-Corral A, Yun J, Pressman G . Infective endocarditis epidemiology over five decades: a systematic review. PLoS One. 2013; 8(12):e82665. PMC: 3857279. DOI: 10.1371/journal.pone.0082665. View

Jiang X, Liu J, Khan F, Tang R, Zhang Y, Gu T . Aortic and mitral valve surgery for infective endocarditis with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes. J Thorac Dis. 2020; 12(4):1427-1436. PMC: 7212136. DOI: 10.21037/jtd.2020.03.04. View

Bohbot Y, Habib G, Laroche C, Stohr E, Chirouze C, Hernandez-Meneses M . Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) registry. Eur J Heart Fail. 2022; 24(7):1253-1265. PMC: 9543970. DOI: 10.1002/ejhf.2525. View

Pericas J, Hernandez-Meneses M, Munoz P, Martinez-Selles M, Alvarez-Uria A, de Alarcon A . Characteristics and Outcome of Acute Heart Failure in Infective Endocarditis: Focus on Cardiogenic Shock. Clin Infect Dis. 2021; 73(5):765-774. DOI: 10.1093/cid/ciab098. View

Summers M, Leon M, Smith C, Kodali S, Thourani V, Herrmann H . Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials. Circulation. 2019; 140(24):1984-1994. DOI: 10.1161/CIRCULATIONAHA.119.041399. View

10.

Singhal P, Kanjanauthai S, Kwan W . Recurrent Multivalvular Endocarditis Causing Complete Heart Block after TAVR. Case Rep Cardiol. 2021; 2021:5334088. PMC: 8575599. DOI: 10.1155/2021/5334088. View

11.

Matsuura R, Yoshioka D, Toda K, Yokoyama J, Miyagawa S, Yoshikawa Y . Effect of the Initial Strategy for Active Endocarditis Complicated With Acute Heart Failure. Circ J. 2018; 82(11):2896-2904. DOI: 10.1253/circj.CJ-18-0510. View

12.

Karuru U, Relan J, Kothari S, Gupta S, Talwar S . Infective endocarditis-induced complete closure of a ventricular septal defect and complete heart block in a child. Ann Pediatr Cardiol. 2022; 14(4):527-529. PMC: 9075550. DOI: 10.4103/apc.apc_17_21. View

13.

Jamil M, Sultan I, Gleason T, Navid F, Fallert M, Suffoletto M . Infective endocarditis: trends, surgical outcomes, and controversies. J Thorac Dis. 2020; 11(11):4875-4885. PMC: 6940216. DOI: 10.21037/jtd.2019.10.45. View

14.

Jaffe W, Morgan D, Pearlman A, Otto C . Infective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality. J Am Coll Cardiol. 1990; 15(6):1227-33. DOI: 10.1016/s0735-1097(10)80005-1. View

15.

Hasebe H, Takanohashi A, Shirota K, Nakamura H . Infective Endocarditis with Intermittent Atrioventricular Block and Pseudoaneurysm of the Mitral-aortic Intervalvular Fibrosa in a Patient with Severe Aortic Stenosis. Intern Med. 2016; 55(19):2825-2829. PMC: 5088544. DOI: 10.2169/internalmedicine.55.7031. View

16.

Singh N, Kalathiya R . Transient complete heart block: a case report of a rare complication of tricuspid valve infective endocarditis. Eur Heart J Case Rep. 2021; 5(8):ytab287. PMC: 8374981. DOI: 10.1093/ehjcr/ytab287. View