# Evolution of Management and Outcomes of Infective Endocarditis After Introducing the Endocarditis Team

## TL;DR

This study examines how the management and outcomes of infective endocarditis changed over time after introducing an endocarditis team, finding increased use of diagnostics but stable mortality rates.

## Contribution

The study provides evidence of evolving management practices and outcomes in infective endocarditis with the implementation of an endocarditis team over time.

## Key findings

- The percentage of patients with rediscussions increased significantly over time.
- Cardiac CT and PET-CT usage increased, while the need for additional diagnostic tests and treatment changes decreased.
- One-year survival remained stable at approximately 80% despite changes in management.

## Abstract

Current guidelines recommend discussing patients with infective endocarditis in an endocarditis team (ET). The benefits of an ET have been established, but not the evolution over time.

The objective of the study was to investigate changes in management and outcomes in infective endocarditis over time.

All patients discussed by our ET since 2016 were prospectively included and divided into 3 cohorts. Trends over time for the number of discussions, diagnostics, ET recommendations, treatment, and outcomes were assessed using Poisson, logistic, and Cox regression, respectively, adjusted for potential case mix.

The total cohort included 1,042 patients, with 223, 364, and 455 patients in cohorts 1 (2016-2018), 2 (2019-2021), and 3 (2022-2024), respectively. The percentage of patients with a rediscussion increased with 18.2% (P < 0.001), and the number of discussions per patient increased with 3% per diagnosis-year (P = 0.006). The percentage of patients with positive blood cultures decreased with 17.5% (P < 0.001), whereas cardiac computed tomography (CT) and positron emission tomography (PET) CT usage increased with 3.1% (P = 0.028) and 12.5% (P < 0.001), respectively. Advice for additional diagnostic tests decreased by 11.6% (P < 0.001), and treatment change decreased by 18.3% (P < 0.001). Reclassification of the initial diagnosis increased with 8.3% (P = 0.045). Relapse (P = 0.82) and reinfection rates did not change (P = 0.98). One-year survival was approximately 80% and remained stable (P = 0.62).

There were more referrals and rediscussions, but less need for additional advice, reflecting increased familiarity with and a learning effect of the ET. CT and PET-CT were used more often. Mortality did not change over time and remained high.