Infectious Endocarditis in the Elderly – Comparative Study of Clinical Features, Course and Outcomes

Abstract

In the context of the increased incidence of infectious endocarditis (IE) in the elderly, an assessment of clinical features of IE in elderly patients is still controversial.Aim. To study the clinical features and outcomes of IE in patients aged ≥65 years.Material and methods. А comparative assessment of risk factors, etiology, clinical manifestations, outcomes was performed in 75 IE patients ≥65 years old and in 356 IE patients <65 years old.Results. In patients ≥65 years old IE was more often associated with previous medical care (odds ratio [OR]=14.9; 95% confidence interval [95%CI] 8.6;25.9), infections and tumors of the genitourinary system or tumors of the gastrointestinal tract (OR=12.6; 95%CI 6.4;24.6); there were more concomitant oncological diseases (OR=66.2; 95%CI 19.3;226.8), diabetes mellitus (OR=9.9; 95%CI 4.5;22.1), chronic kidney disease (OR=27.0; 95%CI 13.6;53.3). In patients ≥65 years old compared with non-drug users IE patients <65 years old (n=266), the incidence of enterococcal IE was higher (OR=3.3; 95%CI 1.4;7.9); the timing of IE diagnosis was longer – 60 (37;152) vs 30 (20;110) days (p<0.05); cardiac surgery was performed less often (8% vs 24.8%; p<0.05); in-hospital mortality was almost two-fold higher. However, with the exclusion from the mortality rate assessment of postmortem diagnosed IE cases in-hospital mortality in patients ≥65 years old and patients <65 years old did not differ significantly (14.8% vs 12.2% in non-drug users <65 years old and 14.9% in drug-users IE).Conclusion. Late diagnosis of IE and comorbidity, which limits the possibility of cardiac surgery, are the most important prognostic unfavorable features of IE in the elderly.

Keywords

• infectious endocarditis
• elderly
• etiology
• clinic
• outcome