Featured Research

from universities, journals, and other organizations

Among patients with infective endocarditis and heart failure, valvular surgery associated with reduced mortality

Date:
November 29, 2011
Source:
JAMA and Archives Journals
Summary:
Among patients with infective endocarditis and heart failure, about two-thirds undergo valvular surgery, which is associated with a significant reduction in the risk of death in the hospital and at one year, according to a new study.

Among patients with infective endocarditis (an infection of the heart lining which may involve the heart valves) and heart failure, about two-thirds undergo valvular surgery, which is associated with a significant reduction in the risk of death in the hospital and at one year, according to a study in the Nov. 23/30 issue of JAMA.

"Infective endocarditis is associated with substantial morbidity and mortality. Several published studies have reported in-hospital mortality of 15 percent to 20 percent and l-year mortality of 40 percent. In the United States alone, approximately 15,000 new cases of infective endocarditis are diagnosed each year. A variety of complications contribute to the high rates of morbidity and mortality in infective endocarditis, particularly heart failure (HF), which occurs in approximately 40 percent of patients," according to background information in the article. Several observational studies have shown a reduction in the risk of death for infective endocarditis complicated by HF with valvular surgery, and this indication for surgery is strongly recommended in current American College of Cardiology/American Heart Association and European Society of Cardiology guidelines.

Todd Kiefer, M.D., Ph.D., of Duke University Medical Center, Durham, N.C., and colleagues conducted a study to examine the clinical, echocardiography, and microbiological variables associated with the development of HF in patients with infective endocarditis and examined variables associated with in-hospital and 1-year mortality, including the use and effects of surgery on outcome. The study included 4,166 patients with native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006.

Among 4,075 patients with infective endocarditis and known HF status, 1,359 (33.4 percent) had HF, and 906 (66.7 percent) were classified as having New York Heart Association class III or IV symptom status (greater degree of limitations/symptoms with physical activity). Within the subset with HF, 839 (61.7 percent) underwent valvular surgery during the index hospitalization. The researchers found that in-hospital mortality was 29.7 percent for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6 percent vs. 44.8 percent, respectively). In addition, one-year mortality was 29.1 percent in patients undergoing valvular surgery vs. 58.4 percent in those not undergoing surgery.

Factors independently associated with 1-year mortality included advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications. Valvular surgery during the initial hospitalization was associated with lower mortality.

The authors note that their finding that nearly one-third of patients with HF and high surgical propensity did not have surgery emphasizes the need for multi-disciplinary, guideline-based management of infective endocarditis. "Improved recognition of HF and institutional systems to promote appropriate treatment of infective endocarditis may enhance the rate of surgery for this indication."

"Additional studies are needed to better risk-stratify patients with infective endocarditis and HF and optimize the use of surgery for this serious condition."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. T. Kiefer, L. Park, C. Tribouilloy, C. Cortes, R. Casillo, V. Chu, F. Delahaye, E. Durante-Mangoni, J. Edathodu, C. Falces, M. Logar, J. M. Miro, C. Naber, M. F. Tripodi, D. R. Murdoch, P. Moreillon, R. Utili, A. Wang. Association Between Valvular Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Heart Failure. JAMA: The Journal of the American Medical Association, 2011; 306 (20): 2239 DOI: 10.1001/jama.2011.1701

Cite This Page:

JAMA and Archives Journals. "Among patients with infective endocarditis and heart failure, valvular surgery associated with reduced mortality." ScienceDaily. ScienceDaily, 29 November 2011. <www.sciencedaily.com/releases/2011/11/111122162822.htm>.
JAMA and Archives Journals. (2011, November 29). Among patients with infective endocarditis and heart failure, valvular surgery associated with reduced mortality. ScienceDaily. Retrieved October 21, 2014 from www.sciencedaily.com/releases/2011/11/111122162822.htm
JAMA and Archives Journals. "Among patients with infective endocarditis and heart failure, valvular surgery associated with reduced mortality." ScienceDaily. www.sciencedaily.com/releases/2011/11/111122162822.htm (accessed October 21, 2014).

Share This



More Health & Medicine News

Tuesday, October 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

How Nigeria Beat Its Ebola Outbreak

How Nigeria Beat Its Ebola Outbreak

Newsy (Oct. 20, 2014) The World Health Organization has declared Nigeria free of Ebola. Health experts credit a bit of luck and the government's initial response. Video provided by Newsy
Powered by NewsLook.com
Another Study Suggests Viagra Is Good For The Heart

Another Study Suggests Viagra Is Good For The Heart

Newsy (Oct. 20, 2014) An ingredient in erectile-dysfunction medications such as Viagra could improve heart function. Perhaps not surprising, given Viagra's history. Video provided by Newsy
Powered by NewsLook.com
Ebola Worries End for Dozens on U.S. Watch Lists

Ebola Worries End for Dozens on U.S. Watch Lists

Reuters - US Online Video (Oct. 20, 2014) Forty-three people who had contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., were cleared overnight of twice-daily monitoring after 21 days of showing no symptoms. Rough Cut (no reporter narration). Video provided by Reuters
Powered by NewsLook.com
CDC Calls for New Ebola Safety Guidelines

CDC Calls for New Ebola Safety Guidelines

AP (Oct. 20, 2014) Centers for Disease Control and Prevention Director Dr. Tom Frieden laid out new guidelines for health care workers when dealing with the deadly Ebola virus including new precautions when taking off personal protective equipment. (Oct. 20) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins