Surgery is underused in elderly patients with left-sided infective endocarditis : A nationwide registry study
(2021) In Journal of the American Heart Association 10(19).- Abstract
BACKGROUND: Infective endocarditis is associated with higher mortality in elderly patients, but the role of surgery in this group has not been fully evaluated. The aim of this study was to assess outcomes of left-sided infective endocarditis in elderly patients and to determine the influence of surgery on mortality in the elderly. METHODS AND RESULTS: A nationwide retrospective study was performed of 2186 patients with left-sided infective endocar-ditis recorded in the SRIE (Swedish Registry of Infective Endocarditis), divided into patients aged <65 years (n=864), 65 to 79 years (n=806), and ≥80 years (n=516). Survival analysis was performed using the Swedish National Population Registry, and propensity score matching was applied to... (More)
BACKGROUND: Infective endocarditis is associated with higher mortality in elderly patients, but the role of surgery in this group has not been fully evaluated. The aim of this study was to assess outcomes of left-sided infective endocarditis in elderly patients and to determine the influence of surgery on mortality in the elderly. METHODS AND RESULTS: A nationwide retrospective study was performed of 2186 patients with left-sided infective endocar-ditis recorded in the SRIE (Swedish Registry of Infective Endocarditis), divided into patients aged <65 years (n=864), 65 to 79 years (n=806), and ≥80 years (n=516). Survival analysis was performed using the Swedish National Population Registry, and propensity score matching was applied to assess the effect of surgery on survival among patients of all ages. The rate of surgery decreased with increasing age, from 46% in the <65 group to 6% in the ≥80 group. In-hospital mortality was 3 times higher in the ≥80 group compared with the <65 group (23% versus 7%) and almost twice that of the 65 to 79 group (12%). In propensity-matched groups, the mortality rate was significantly lower between the ages of 55 and 82 years in patients who underwent surgery compared with patients who did not undergo surgery. Surgery was also associated with better long-term survival in matched patients who were ≥75 years (hazard ratio, 0.36; 95% CI, 0.24– 0.54 [P<0.001]). CONCLUSIONS: The proportion of elderly patients with infective endocarditis who underwent surgery was low compared with that of younger patients. Surgery was associated with lower mortality irrespective of age. In matched elderly patients, long-term mortality was higher in patients who did not undergo surgery, suggesting that surgery is underused in elderly patients.
(Less)
- author
- Ragnarsson, Sigurdur LU ; Salto-Alejandre, Sonsoles ; Ström, Axel ; Olaison, Lars and Rasmussen, Magnus LU
- organization
- publishing date
- 2021-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Elderly, Infective endocarditis, Outcome, Valve surgery
- in
- Journal of the American Heart Association
- volume
- 10
- issue
- 19
- article number
- e020221
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85118097656
- pmid:34558291
- ISSN
- 2047-9980
- DOI
- 10.1161/JAHA.120.020221
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. Th.
- id
- 7f1f6239-1439-4d81-88db-ca6a072a5f42
- date added to LUP
- 2021-11-22 12:58:35
- date last changed
- 2024-06-16 23:42:25
@article{7f1f6239-1439-4d81-88db-ca6a072a5f42,
abstract = {{<p>BACKGROUND: Infective endocarditis is associated with higher mortality in elderly patients, but the role of surgery in this group has not been fully evaluated. The aim of this study was to assess outcomes of left-sided infective endocarditis in elderly patients and to determine the influence of surgery on mortality in the elderly. METHODS AND RESULTS: A nationwide retrospective study was performed of 2186 patients with left-sided infective endocar-ditis recorded in the SRIE (Swedish Registry of Infective Endocarditis), divided into patients aged <65 years (n=864), 65 to 79 years (n=806), and ≥80 years (n=516). Survival analysis was performed using the Swedish National Population Registry, and propensity score matching was applied to assess the effect of surgery on survival among patients of all ages. The rate of surgery decreased with increasing age, from 46% in the <65 group to 6% in the ≥80 group. In-hospital mortality was 3 times higher in the ≥80 group compared with the <65 group (23% versus 7%) and almost twice that of the 65 to 79 group (12%). In propensity-matched groups, the mortality rate was significantly lower between the ages of 55 and 82 years in patients who underwent surgery compared with patients who did not undergo surgery. Surgery was also associated with better long-term survival in matched patients who were ≥75 years (hazard ratio, 0.36; 95% CI, 0.24– 0.54 [P<0.001]). CONCLUSIONS: The proportion of elderly patients with infective endocarditis who underwent surgery was low compared with that of younger patients. Surgery was associated with lower mortality irrespective of age. In matched elderly patients, long-term mortality was higher in patients who did not undergo surgery, suggesting that surgery is underused in elderly patients.</p>}},
author = {{Ragnarsson, Sigurdur and Salto-Alejandre, Sonsoles and Ström, Axel and Olaison, Lars and Rasmussen, Magnus}},
issn = {{2047-9980}},
keywords = {{Elderly; Infective endocarditis; Outcome; Valve surgery}},
language = {{eng}},
number = {{19}},
publisher = {{Wiley-Blackwell}},
series = {{Journal of the American Heart Association}},
title = {{Surgery is underused in elderly patients with left-sided infective endocarditis : A nationwide registry study}},
url = {{http://dx.doi.org/10.1161/JAHA.120.020221}},
doi = {{10.1161/JAHA.120.020221}},
volume = {{10}},
year = {{2021}},
}