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Infective Endocarditis in elderly - Predictors of 1 year mortality
Session:
Sessão de Posters 44 - Endocardite Infecciosa
Speaker:
Fernando Lima do Nascimento Ferreira
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:
Fernando Nascimento Ferreira; Barbara Teixeira; Rita Ilhão Moreira; Miguel Figueiredo; Julien Lopes; Francisco Albuquerque; Madalena Coutinho Cruz; Ana Galrinho; Ana Teresa Timóteo; Pedro Rio; Luísa Moura Branco; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> The prevalence of infective endocarditis (IE) has been increasing in the elderly population due to the observed rise in life expectancy. The individual comorbidities prevalent in this age group make approaching this pathology challenging. Therefore, it is crucial to identify potential prognostic predictors.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong> To evaluate possible predictors of 1-year mortality in individuals over 80 years old diagnosed with IE.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methodology:</strong> A retrospective study included patients aged 80 years or older with a definitive diagnosis of IE, according to the 2023 guidelines of the European Society of Cardiology, who underwent transesophageal echocardiography at a Cardiology center in a tertiary hospital between 2015 and 2021. Demographic, clinical, echocardiographic, and prognostic characteristics were assessed, and their association with 1-year mortality was evaluated.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 30 patients were included, with 63.3% male, with mean age of 84 years (±3.0). The assessment by the Clinical Frailty Scale (CFS) revealed scores between 4 and 7 (4 - 56.7%, 5 - 6.7%, 6 - 20%, and 7 - 6.7%). 40% had history of atrial fibrillation, 56.7% had prior cardiac surgery, 40% had valvular prosthesis, 36.7% had cardiac device (CD), 36.7% had hospitalization or invasive procedure in the 3 months preceding the diagnosis and 6.7% had previous IE. The average Euroscore II was 10.2 (±6.8), and the average mortality assessed by the STS score was 11.81 (±6.49). The most frequent manifestation was fever (93.3%), the aortic valve was the most affected (54.9%), with multivalvular involvement in 10% of cases and the most common echocardiographic finding was vegetation (93.7%). Staphylococcus spp was the most frequent microorganism (26.1%), followed by organisms from the gallolyticus group and Pyogenes, and Enterococci (each in 20% of cases). The most common complication was heart failure (26.7%). Cerebral embolization occurred in 13.3% of individuals, and peripheral embolization in 16.7%. Regarding therapeutic context, 43,3% had surgical indication, and 13.3% underwent surgical intervention. In-hospital and 1-year mortality was 23,3% and 36.7%, respectively.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Concerning 1-year mortality, a statistically significant association was observed with CFS (p=0.003), with a positive coefficient for scores higher than 4, and history of CD (HR 6.4 (1.156-35.437); p=0.047), the second not independently. It is noteworthy that there was no significant association between surgical indication and its performance with 1-year mortality (OR 2.057 (0.455-9.304); OR 0.533 (0.049-5.862)).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> The study revealed a clinically significant context with a notable prevalence of cardiovascular comorbidities and elevated surgical risk scores. One-year mortality seems to be associated with patients with higher pre-existing frailty and a history of CD, with no apparent association with surgical intervention. </span></span></span></p>
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