Quality of care of hospitalized infective endocarditis patients: Report from a tertiary medical center

Mohammad Amin Kashef, Jennifer Friderici, Jaime Hernandez-Montfort, Auras R. Atreya, Peter Lindenauer, Tara Lagu

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

OBJECTIVE: There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). PATIENTS AND METHODS: We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1-year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). RESULTS: Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline-recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6-month readmission and 12-month mortality. CONCLUSION: IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation.

Original languageEnglish (US)
Pages (from-to)414-420
Number of pages7
JournalJournal of hospital medicine
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

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    Kashef, M. A., Friderici, J., Hernandez-Montfort, J., Atreya, A. R., Lindenauer, P., & Lagu, T. (2017). Quality of care of hospitalized infective endocarditis patients: Report from a tertiary medical center. Journal of hospital medicine, 12(6), 414-420. https://doi.org/10.12788/jhm.2746