CHD tied to better prognosis in infective endocarditis

Among patients with infective endocarditis (IE), the presence of congenital heart disease (CHD) appears to be correlated with better short- and long-term outcomes, a new study has found.

Of 3,111 IE patients (mean age 59.3 years, 68.9 percent men), 11.7 percent (n=365) had CHD. Most had problems related to the aortic valve. Other issues included ventricular septum defect, atrioventricular septum defect, and disorders of the right ventricular outflow tract. Among the CHD patients, the mean age of IE diagnosis was 44.8 years.

Clinical presentation of IE did not differ between CHD and non-CHD patients, primarily manifesting as fever (81.3 percent) or general non-wellbeing (52.1 percent). In contrast, CHD patients had a significantly longer time between symptom presentation and admission (35.6 vs 28.7 days; p=0.004).

Overall, 33 CHD patients died in the hospital, yielding a mortality rate of 9.0 percent. This was significantly lower than that in non-CHD counterparts, in whom in-hospital death rate was 18.1 percent (p<0.001). Overall, the 1-year all-cause mortality rate was also lower in the CHD group (12.9 percent vs 24.5 percent; p<0.001).

Cox regression analysis after propensity score matching showed that non-CHD IE patients were 70 percent more likely to die in the hospital than CHD comparators (hazard ratio, 1.70, 95 percent confidence interval, 1.08–2.68; p=0.02).

“Pre-hospital delay is important and needs attention. As compared to non-CHD patients, CHD patients with IE have a better outcome in terms of all-cause mortality, despite the presence of more advanced disease at admission,” the researchers said.