The Mortality of Infective endocarditis with and without Surgery in Elderly (MoISE) Study
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND: Infective endocarditis (IE) is increasingly affecting older patients. However, data on their management are sparse, and the benefits of surgery in this population are unclear.
METHODS: We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France, from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression.
RESULTS: We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson comorbidity index. Moreover, they had better functional status at admission (ie, the ability to walk unassisted and a higher median activities of daily living [ADL] score; n = 5/6 vs 3/6, P = .01). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared with those who were not despite a surgical indication (16% vs 66%, P < .001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score <4, there was no significant surgical benefit for 1-year mortality.
CONCLUSIONS: Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:77 |
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| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - 77(2023), 10 vom: 17. Nov., Seite 1440-1448 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hémar, Victor [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiac surgery |
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| Anmerkungen: |
Date Completed 20.11.2023 Date Revised 24.11.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/cid/ciad384 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM358704197 |
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| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Infective endocarditis (IE) is increasingly affecting older patients. However, data on their management are sparse, and the benefits of surgery in this population are unclear | ||
| 520 | |a METHODS: We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France, from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression | ||
| 520 | |a RESULTS: We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson comorbidity index. Moreover, they had better functional status at admission (ie, the ability to walk unassisted and a higher median activities of daily living [ADL] score; n = 5/6 vs 3/6, P = .01). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared with those who were not despite a surgical indication (16% vs 66%, P < .001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score <4, there was no significant surgical benefit for 1-year mortality | ||
| 520 | |a CONCLUSIONS: Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Pernot, Mathieu |e verfasserin |4 aut | |
| 700 | 1 | |a Greib, Carine |e verfasserin |4 aut | |
| 700 | 1 | |a Dijos, Marina |e verfasserin |4 aut | |
| 700 | 1 | |a Wirth, Gaetane |e verfasserin |4 aut | |
| 700 | 1 | |a Chaussade, Hélène |e verfasserin |4 aut | |
| 700 | 1 | |a Peuchant, Olivia |e verfasserin |4 aut | |
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| 700 | 1 | |a Ngo Bell, C |e investigator |4 oth | |
| 700 | 1 | |a Barret, A |e investigator |4 oth | |
| 700 | 1 | |a Videcoq, M |e investigator |4 oth | |
| 700 | 1 | |a Alexandrino, C |e investigator |4 oth | |
| 700 | 1 | |a Vareil, M O |e investigator |4 oth | |
| 700 | 1 | |a Wille, H |e investigator |4 oth | |
| 700 | 1 | |a André, K |e investigator |4 oth | |
| 700 | 1 | |a Nyamankolly, E |e investigator |4 oth | |
| 700 | 1 | |a Girard, D |e investigator |4 oth | |
| 700 | 1 | |a Ducours, M |e investigator |4 oth | |
| 700 | 1 | |a Caubet, O |e investigator |4 oth | |
| 700 | 1 | |a Ferrand, H |e investigator |4 oth | |
| 700 | 1 | |a Lacassin, F |e investigator |4 oth | |
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| 700 | 1 | |a Castan, B |e investigator |4 oth | |
| 700 | 1 | |a Aguilar, C |e investigator |4 oth | |
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