SPC365

Comorbidity and Prognosis in Octogenarians with Infective Endocarditis

Session: Sessão de Posters 44 - Endocardite Infecciosa
Speaker: Liliana Sofia Gonçalves Brochado

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.8 Infective Endocarditis - Other
Session Type: Cartazes
FP Number: ---
Authors: Liliana Brochado; Barbara Ferreira; Paula Fazendas; João Grade; Mariana Martinho; Diogo Cunha; Oliveira Baltazar; João Luz; Nazar Ilchyshyn; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Introduction:</span></span></strong><span style="font-size:10.0pt"><span style="color:black"> Infective endocarditis (IE) is a rare but seemingly increasing disease, particularly among older adults. Management of IE often varies by age group, with a notably low rate of cardiac surgery in octogenarians, attributed partially to heightened surgical risk in advanced age. However, the underutilization of cardiac surgery is linked to unfavorable outcomes in older IE patients. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Purpose: </span></span></span></strong><span style="font-size:10.0pt"><span style="color:black">To describe the characteristics of IE in octogenarians and assess their prognosis. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10.0pt"><span style="color:black">We conducted a retrospective, single-center analysis of patients hospitalized with definite IE from January 2006 to December 2021. The cohort comprised 222 patients divided into two groups: 188 patients aged under 80 years and 34 patients aged over 80 years. We assessed all-cause mortality over a 1-year follow-up period.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Courier New&quot;"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Results: &nbsp;</span></span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">In comparison to patients aged &lt;80 years, those aged &ge;80 years exhibited significantly lower rates of valvular surgery indication (38.6% vs. 5.9%, p&lt;0.001), performed surgery (35.1% vs. 5.9%, p&lt;0.001), and higher 1-year mortality (38.8% vs. 58.8%, p=0.038). Multivariable analysis demonstrated that age alone did not predict mortality, while the absence of a surgical procedure was predictive of worse outcome (51.0% vs. 20.9%, p&lt;0.001; HR 2,922; 95% CI 1,629-5,242). </span></span></span></span>Baseline characteristics, besides gender (higher prevalence of males in &lt;80 years group, 75.0% vs. 55.9%, p=0.036), the remainnig&nbsp;characteristics were similar in both groups<span style="font-size:10pt"><span style="font-family:&quot;Courier New&quot;"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">. The incidence of hypertension between groups was 55,3% vs 64,7%; diabetes mellitus 19,7% vs 17,6%; coronary disease 10,6% vs 14,7%; heart failure 21,8% vs 32,4%; valvular disease 42% vs 52,9%; kidney disease 17,0% vs 8,8% and anemia 49,5% vs 67,6%. Additionally, no statistically significant differences were observed in the incidence of vegetation location: aortic valve (54.3% vs. 55.9%), mitral valve (49.5% vs. 41.2%), and right-sided valves (13.3% vs. 5.9%). The groups also did not differ in the main complications of EI.</span></span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Our study demonstrated high mortality and restricted valvular surgery performance in octogenarians with IE, despite the pivotal role of surgery in achieving successful outcomes. Still, age alone should not be determinant for denying surgery; instead, </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#202124">the assessment of the patient&#39;s frailty emerges as a crucial factor. </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">We consider that a more comprehensive patient assessment, involving the collaboration of geriatricians, and emphasizing shared decision-making may help improve patients&rsquo; outcomes. Therefore, experienced multidisciplinary teams are essential for managing these complex cases. Yet, further research is needed to assess the benefits of IE surgery in the elderly population</span></span></span></p>