Aims Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socioeconomic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multicentre registry.Methods and results The EurObservational Programme (EORP) of the European Society of Cardiology EURO-ENDO (European Infective Endocarditis) registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in three groups, according to World Bank economic stratification [group 1: high income (75.6%); group 2: upper-middle income (15.4%); group 3: lower-middle income (9.1%)]. Group 3 patients were younger [median age (interquartile range, IQR): group 1, 66 (53-75) years; group 2, 57 (41-68) years; group 3, 33 (26-43) years; P < 0.001] with a higher frequency of smokers, intravenous drug use, and human immunodeficiency virus infection (all P < 0.001) and presented later [median (IQR) days since symptom onset: group 1, 12 (3-35); group 2, 19 (6-54); group 3, 31 (12-62); P < 0.001] with a higher likelihood of developing congestive heart failure (13.6%, 11.1%, and 22.6%, respectively; P < 0.001) and persistent fever (9.8%, 14.2%, and 27.9%, respectively; P < 0.001). Among 2157 (69.3%) patients with theoretical indication for cardiac surgery, surgery was performed less frequently in group 3 patients (75.5%, 76.8%, and 51.3%, respectively; P < 0.001), who also demonstrated the highest mortality (15.0%, 23.0%, and 23.7%, respectively; P < 0.001).Conclusion Socioeconomic factors influence the clinical profile of patients presenting with IE across the world. Despite younger age, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and lower use of surgery.

Socioeconomic variations determine the clinical presentation, aetiology, and outcome of infective endocarditis: a prospective cohort study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry / Sengupta, Shantanu P; Prendergast, Bernard; Laroche, Cécile; Furnaz, Shumaila; Ronderos, Ricardo; Almaghraby, Abdallah; Asch, Federico M; Blechova, Kamila; Zaky, Hosam; Strahilevitz, Jacob; Dworakowski, Rafal; Miyasaka, Yoko; Sebag, Igal; Izumi, Chisato; Axler, Olivier; Jamiel, Abdulrahman; Philip, Mary; Campos Vieira, Marcelo Luiz; Lancellotti, Patrizio; Habib, Gilbert; Argentina:Buenos Aires—I. Granada, M. Mahia, S. Ressi, F. Nacinovich, A. Iribarren, P. Fernandez Oses, G. Avegliano, E. Filipini; Corrientes—R. Obregon, M. Bangher, J. Dho; La Plata: L. Cartasegna, M. L. Plastino, V. Novas, C. Shigel; Florencio Varela—G. Reyes, M. De Santos, N. Gastaldello, M. Granillo Fernandez, M. Potito, G. Streitenberger, P. Velazco, J.H. Casabé, C. Cortes, E. Guevara, F. Salmo, M. Seijo. Austria:Vienna—F. Weidinger, M. Heger, R. Brooks, C. Stöllberger, C.-Y. Ho, L. Perschy, L. Puskas, C. Binder, R. Rosenhek, M. Schneider, M.-P. Winter. Belgium:Liege—E. Hoffer, M. Melissopoulou, E. Lecoq, D. Legrand, S. Jacquet, M. Massoz, L. Pierard, S. Marchetta, R. Dulgheru, C. D´Emal, C. Oury; Jette—S. Droogmans, D. Kerkhove, D. Plein, L. Soens, C. Weytjens, A. Motoc, B. Roosens, I. Lemoine; Edegem—I. Rodrigus, B. Paelinck, B. Amsel; Brussels—P. Unger, D. Konopnicki, C. Beauloye, A. Pasquet, J. L. Vanoverschelde, S. Pierard, D. Vancraeynest, F. Sinnaeve. Brazil:Sao Paulo—J. L. Andrade, K. Staszko; Porto Alegre—R. Dos Santos Monteiro, M. H. Miglioranza, D. L. Shuha; Rio de Janeiro—M. Alcantara, V. Cravo, L. Fazzio, A. Felix, M. Iso, C. Musa, A. P. Siciliano; Marilia—F. Villaca Filho, A. Rodrigues, F. Vilela, J. Braga, R. Silva, D. Rodrigues, L. Silva, S. Morhy, C. Fischer, R. Silva, M. Vieira, T. Afonso; Fortaleza—J. Abreu, S. N. Falcao, V. A. Moises, A. Gouvea, F. J. Mancuso, A. C. Souza, C. Y. Silva, G. João, C. S. Abboud, R. Bellio de Mattos Barretto, A. Ramos, R. Arnoni, J. E. Assef, D. J. Della Togna, D. Le Bihan, L. Miglioli, A. P. Romero Oliveira, R. Tadeu Magro Kroll, D. Cortez; Belo Horizonte—C. L. Gelape, M. d. C. Peirira Nunes, T. C. De Abreu Ferrari. Canada:Ottawa—K. Hay; Montreal—V. Le, M. Page, F. Poulin, C. Sauve, K. Serri, C. Mercure; Quebec—J. Beaudoin, P. Pibarot, I. A. Sebag, L. G. Rudski, G. Ricafort. Croatia:Zagreb: B. Barsic, V. Krajinovic, M. Vargovic, D. Lovric, V. Reskovic-Luksic, J. Vincelj, S. Jaksic Jurinjak; Cyprus:Nicosia—V. Yiannikourides, M. Ioannides, C. Pofaides, V. Masoura; Czech Republic:Ostrava-Poruba—J. Pudich; Prague—A. Linhart, M. Siranec, J. Marek, K. Blechova, M. Kamenik; Hradec Kralove—R. Pelouch; Zlin—Z. Coufal, M. Mikulica, M. Griva, E. Jancova, M. Mikulcova; Olomouc—M. Taborsky, J. Precek, M. Jecmenova, J. Latal; Liberec—J. Widimsky, T. Butta, S. Machacek; Pilsen—R. Vancata; Brno—J. Spinar, M. Holicka. Ecuador:Guayaquil—F. Pow Chon Long, N. Anzules, A. Bajana Carpio, G. Largacha, E. Penaherrera, D. Moreira. Egypt:Mansoura—E. Mahfouz, E. Elsafty, A. Soliman, Y. Zayed, J. Aboulenein; Alexandria—M. Abdel-Hay, A. Almaghraby, M. Abdelnaby, M. Ahmed, B. Hammad, Y. Saleh, H. Zahran, O. Elgebaly; Zagazig—A. Saad, M. Ali, A. Zeid, R. El Sharkawy; Cairo—A. Al Kholy, R. Doss, D. Osama, H. Rizk, A. Elmogy, M. Mishriky. France:Kremlin-Bicêtre— P. Assayag, S. El Hatimi; Marseille: S. Hubert, J.-P. Casalta, F. Gouriet, F. Arregle, S. Cammilleri, L. Tessonnier, A. Riberi; Saint-Etienne—E. Botelho-Nevers, A. Gagneux-Brunon, R. Pierrard, C. Tulane, S. Campisi, J.-F. Fuzellier, M. Detoc, T. Mehalla; Nantes—D. Boutoille, A. S. Lecompte, M. Lefebvre, S. Pattier, O. Al Habash, N. Asseray-Madani, C. Biron, J. Brochard, J. Caillon, C. Cueff, T. Le Tourneau, R. Lecomte, M. M. Magali Michel, J. Orain, S. Delarue, M. Le Bras; Limoges—J.-F. Faucher, V. Aboyans, A. Beeharry, H. Durox, M. Lacoste, J. Magne, D. Mohty, A. David, V. Pradel; Thonon-les-Bains—V. Sierra, A. Neykova, B. Bettayeb, S. Elkentaoui, B. Tzvetkov, G. Landry; Reims—C. Strady, K. Ainine, S. Baumard, C. Brasselet, C. Tassigny, V. Valente-Pires, M. Lefranc; Pointe-à-Pitre—B. Hoen, B. Lefevre, E. Curlier, C. Callier, N. Fourcade; Brest—Y. Jobic, S. Ansard, R. Le Berre, F. Le Ven, M.-C. Pouliquen, G. Prat, P. Le Roux.; Rouen—F. Bouchart, A. Savoure, C. Alarcon, C. Chapuzet, I. Gueit; Amiens—C. Tribouilloy, Y. Bohbot, F. Peugnet, M. Gun; Paris—X. Duval, X. Lescure, E. Ilic-Habensus; Nancy: N. Sadoul, C. Selton-Suty, F. Alla, F. Goehringer, O. Huttin, E. Chevalier; Poitiers—R. Garcia, V. Le Marcis; Rennes—P. Tattevin, E. Flecher, M. Revest; Besançon—C. Chirouze, K. Bouiller, L. Hustache-Mathieu, T. Klopfenstein, J. Moreau, D. Fournier, A.-S. Brunel; Créteil—P. Lim, L. Oliver, J. Ternacle, A. Moussafeur; Dijon—P. Chavanet, L. Piroth, A. Salmon-Rousseau, M. Buisson, S. Mahy, C. Martins, S. Gohier; Noumea—O. Axler, F. Baumann, S. Lebras. Germany:Bad Oeynhausen—C. Piper, D. Guckel, J. Börgermann, D. Horstkotte, E. Winkelmann, B. Brockmeier; Leipzig—D. Grey; Bonn—G. Nickenig, R. Schueler, C. Öztürk, E. Stöhr; Bad Nauheim—C. Hamm, T. Walther, R. Brandt, A.-C. Frühauf, C. T. Hartung, C. Hellner, C. Wild; Aachen—M. Becker, S. Hamada, W. Kaestner; Berlin—K. Stangl, F. Knebel, G. Baldenhofer, A. Brecht, H. Dreger, C. Isner, F. Pfafflin, M. Stegemann; Ludwigshafen—R. Zahn, B. Fraiture, C. Kilkowski, A.-K. Karcher, S. Klinger, H. Tolksdorf. Greece:Athens—D. Tousoulis, C. Aggeli, S. Sideris, E. Venieri, G. Sarri, D. Tsiapras, I. Armenis, A. Koutsiari, G. Floros, C. Grassos, S. Dragasis, L. Rallidis, C. Varlamos; Ioannina—L. Michalis, K. Naka, A. Bechlioulis, A. Kotsia, L. Lakkas, K. Pappas, C. Papadopoulos, S. Kiokas, A. Lioni, S. Misailidou, J. Barbetseas, M. Bonou, C. Kapelios, I. Tomprou, K. Zerva; Voula—A. Manolis, E. Hamodraka, D. Athanasiou, G. Haralambidis, H. Samaras, L. Poulimenos. Hungary:Budapest—A. Nagy, A. Bartykowszki, E. Gara. India:Nagpur—K. Mungulmare; Gurgaon—R. Kasliwal, M. Bansal, S. Ranjan, A. Bhan. Iran:Tehran—M. Kyavar, M. Maleki, F. Noohi Bezanjani, A. Alizadehasl, S. Boudagh, A. Ghavidel, P. Moradnejad, H. R. Pasha, B. Ghadrdoost. Israel:Jerusalem—D. Gilon, J. Strahilevitz, M. Wanounou, S. Israel. Italy:Bari—C. d'Agostino, P. Colonna, L. De Michele, F. Fumarola, M. Stante; Florence—N. Marchionni, V. Scheggi, B. Alterini, S. Del Pace, P. Stefano, C. Sparano; Padova—N. Ruozi, R. Tenaglia, D. Muraru; Grosseto—U. Limbruno, A. Cresti, P. Baratta, M. Solari; Milan—C. Giannattasio, A. Moreo, B. De Chiara, B. Lopez Montero, F. Musca, C. A. Orcese, F. Panzeri, F. Spano, C. F. Russo, O. Alfieri, M. De Bonis, S. Chiappetta, B. Del Forno, M. Ripa, P. Scarpellini, C. Tassan Din, B. Castiglioni, R. Pasciuta, S. Carletti, D. Ferrara, M. Guffanti, G. Iaci, E. Lapenna, T. Nisi, C. Oltolini, E. Busnardo, U. Pajoro, E. Agricola, R. Meneghin, D. Schiavi; Salerno—F. Piscione, R. Citro, R. M. Benvenga, L. Greco, L. Soriente, I. Radano, C. Prota, M. Bellino, D. Di Vece; Genoa—F. Santini, A. Salsano, G. M. Olivieri; Modena—F. Turrini, R. Messora, S. Tondi, A. Olaru, V. Agnoletto, L. Grassi, C. Leonardi, S. Sansoni; Turin—S. Del Ponte, G. M. Actis Dato, A. De Martino. Japan:Nagoya—N. Ohte, S. Kikuchi, K. Wakami; Tsukuba—K. Aonuma, Y. Seo, T. Ishizu, T. Machino-Ohtsuka, M. Yamamoto, N. Iida, H. Nakajima; Tenri—Y. Nakagawa, C. Izumi, M. Amano, M. Miyake, K. Takahashi; Osaka: I. Shiojima, Y. Miyasaka, H. Maeba, Y. Suwa, N. Taniguchi, S. Tsujimoto; Kobe—T. Kitai, M. Ota; Sapporo—S. Yuda, S. Sasaki; Tokyo—N. Hagiwara, K. Yamazaki, K. Ashihara, K. Arai, C. Saitou, S. Saitou, G. Suzuki; Miyazaki—Y. Shibata, N. Watanabe, S. Nishino, K. Ashikaga, N. Kuriyama, K. Mahara, T. Okubo, H. Fujimaki, H. Shitan, H. Yamamoto, K. Abe, M. Terada, S. Takanashi; Tokushima—M. Sata, H. Yamada, K. Kusunose, Y. Saijo, H. Seno, O. Yuichiro; Suita—T. Onishi, F. Sera, S. Nakatani, H. Mizuno, K. Sengoku. Republic of Korea:Seoul—S. W. Park, K. Eun Kyoung, L. Ga Yeon, J-w. Hwang, C. Jin-Oh, S.-J. Park, L. Sang-Chol, C. Sung-A, S. Y. Jang, R. Heo, S. Lee, J.-M. Song, E. Jung. Lithuania:Siauliai—J. Plisiene, A. Dambrauskaite, G. Gruodyte; Kaunas—R. Jonkaitiene, V. Mizariene, J. Atkocaityte, R. Zvirblyte. Luxembourg:Luxembourg—R. Sow, A. Codreanu, T. Staub, C. Michaux, E.C.L. De la Vega, L. Jacobs-Orazi. Malta:Msida—C. Mallia Azzopardi, R. G. Xuereb, T. Piscopo, J. Farrugia, M. Fenech, E. Pllaha, C. Vella, D. Borg, R. Casha. Republic of Moldova:Chisinau—L. Grib, E. Raevschi, A. Grejdieru, D. Kravcenco, E. Prisacari, E. Samohvalov, S. Samohvalov, N. Sceglova, E. Panfile, L. Cardaniuc, V. Corcea, A. Feodorovici, V. Gaina, L. Girbu, P. Jimbei, G. Balan, I. Cardaniuc, I. Benesco, V. Marian, N. Sumarga. Montenegro:Podgorica—B. Bozovic, N. Bulatovic, P. Lakovic, L. Music. Netherlands:Rotterdam—R. Budde, A. Wahadat, T. Gamela; Amsterdam—T. Meijers; Groningen—J. P. Van Melle, V. M. Deursen; Maastricht—H. J. Crijns, S. C. Bekkers, E. C. Cheriex, M. Gilbers, B. L. Kietselaer, C. Knackstedt, R. Lorusso, S. Schalla, S. A. Streukens; Utrecht—S. Chamuleau, M.-J. Cramer, A. Teske, T. Van der Spoel, A. Wind, J. Lokhorst, O. Liesbek, H. Van Heusden; The Hague—W. Tanis, I. Van der Bilt, J. Vriend, H. De Lange-van Bruggen, E. Karijodikoro, R. Riezebos, E. van Dongen, J. Schoep, V. Stolk. Norway:Oslo—J. T. Offstad, J. O. Beitnes, T. Helle-Valle, H. Skulstad, R. Skardal. Pakistan:Karachi—N. Qamar, S. Furnaz, B. Ahmed, M. H. Butt, M. F. Khanzada, T. Saghir, A. Wahid. Poland:Warsaw—T. Hryniewiecki, P. Szymanski, K. Marzec, M. Misztal-Ogonowska; Wroclaw—W. Kosmala, M. Przewlocka-Kosmala, A. Rojek, K. Woznicka, J. Zachwyc; Bialystok—A. Lisowska, M. Kaminska; Lodz—J. D. Kasprzak, E. Kowalczyk, D. F. Strzecka, P. Wejner-Mik. Portugal:Carnaxide—M. Trabulo, P. Freitas, S. Ranchordas, G. Rodrigues; Guilhufe—P. Pinto, C. Queiros, J. Azevedo, L. Marques, D. Seabra; Lisbon—L. Branco, J. Abreu, M. Cruz, A. Galrinho, R. Moreira, P. Rio, A.T. Timoteo, M. Selas, V. Carmelo, B. Duque Neves; Almada—H. Pereira, A. Guerra, A. Marques, I. Pintassilgo. Romania:Timisoara—M. C. Tomescu, N.-M. Trofenciuc, M. Andor, A. Bordejevic, H. S. Branea, F. Caruntu, L. A. Velcean, A. Mavrea, M. F. Onel, T. Parvanescu, D. Pop, A. L. Pop-Moldovan, M. I. Puticiu, L. Cirin, I. M. Citu, C. A. Cotoraci, D. Darabantiu, R. Farcas, I. Marincu, A. Ionac, D. Cozma, C. Mornos, F. Goanta, I. Popescu; Cluj-Napoca—R. Beyer, R. Mada, R. Rancea, R. Tomoaia, H. Rosianu, C. Stanescu. Russian Federation:Moscow—Z. Kobalava, J. Karaulova, E. Kotova, A. Milto, A. Pisaryuk, N. Povalyaev, M. Sorokina. Saudi Arabia:Jeddah—J. Alrahimi, A. Elshiekh; Riyadh—A. Jamiel, A. Ahmed, N. Attia. Serbia:Belgrade—B. Putnikovic, A. Dimic, B. Ivanovic, S. Matic, D. Trifunovic, J. Petrovic, D. Kosevic, I. Stojanovic, I. Petrovic, P. Dabic, P. Milojevic; Sremska Kamenica—I. Srdanovic, S. Susak, L. Velicki, A. Vulin, M. Kovacevic, A. Redzek, M. Stefanovic. Singapore:Singapore—T. C. Yeo, W. KF Kong, K. K. Poh. Spain:Madrid—I. Vilacosta, C. Ferrera, C. Olmos, M. Abd El- Nasser; Vigo-Pontevedra—F. Calvo Iglesias, E. Blanco-Gonzalez, M. Bravo Amaro, E. Lopez-Rodriguez, J. Lugo Adan, A. N. Germinas, P. Pazos-Lopez, M. Pereira Loureiro, M. T. Perez, S. Raposeiras-Roubin, S. Rasheed Yas, M.-M. Suarez-Varela, F. Vasallo Vidal; Barcelona—D. Garcia-Dorado, N. Fernandez-Hidalgo, T. Gonzalez-Alujas, J. Lozano, O. Maisterra, N. Pizzi, R. Rios; Badalona—A. Bayes-Genis, L. Pedro Botet, N. Vallejo, C. Llibre, L. Mateu, R. Nunez, D. Quesada, E. Berastegui; Girona—D. Bosch Portell, J. Aboal Vinas, X. Albert Bertran, R. Brugada Tarradellas, P. Loma-Osorio Ricon, C. Tiron de Llano; Valencia—M. A. Arnau, A. Bel, M. Blanes, A. Osa; Cordoba—M. Anguita, F. Carrasco, J. C. Castillo, J. L. Zamorano, J. L. Moya Mur, M. Alvaro, C. Fernandez-Golfin, J. M. Monteagudo, E. Navas Elorza; Santander—M. C. Farinas Alvarez, J. Aguero Balbin, J. Zarauza, J. F. Gutierrez-Diez, C. Arminanzas, F. Arnaiz de las Revillas, A. Arnaiz Garcia, M. Cobo Belaustegui, M. Fernandez Sampedro, M. Gutierrez Cuadra, L. Garcia Cuello, C. Gonzalez Rico; Barakaldo—R. Rodriguez-Alvarez, J. Goikoetxea, M. Montejo, J. M. Miro, M. Almela, J. Ambrosioni, A. Moreno, E. Quintana, E. Sandoval, A. Tellez, J. M. Tolosana, B. Vidal, C. Falces, D. Fuster, C. Garcia-de-la-Maria, M. Hernandez-Meneses, J. Llopis, F. Marco, I. Ruiz-Zamora; Tarragona—A. Bardaji Ruiz, E. Sanz Girgas, G. Garcia-Pardo, M. Guillen Marzo, A. Rodriguez Oviedo, A. Villares Jimenez. Tunisia:Sfax—L. Abid, R. Hammami, S. Kammoun; Tunis—M. S. Mourali, F. Mghaieth Zghal, M. Ben Hlima, S. Boudiche, S. Ouali; La Marsa—L. Zakhama, S. Antit, I. Slama. Turkey:Samsun—O. Gulel, M. Sahin; Ankara—L. E. Sade, E. Karacaglar; Istanbul—S. Kucukoglu, O. Cetinarslan, U. Y. Sinan, U. Canpolat, B. Mutlu, H. Atas, R. Dervishova, C. Ileri. United Arab Emirates:Dubai—J. Alhashmi, J. Tahir, P. Zarger, F. Baslib. United Kingdom:London—S. Woldman, L. Menezes, C. Primus, R. Uppal, I. Bvekerwa; Swindon—B. Chandrasekaran, A. Kopanska, J. Chambers, J. Hancock, J. Klein, R. Rajani, M. P. Ursi, S. Cannata, R. Dworakowski, A. Fife, J. Breeze, M. Browne-Morgan, M. Gunning, S. Streather. United States:Washington—F. M. Asch, M. Zemedkun. Uzbekistan:Tashkent—B. Alyavi, J. Uzokov.. - In: EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES. - ISSN 2058-5225. - ELETTRONICO. - 9:(2022), pp. 85-96. [10.1093/ehjqcco/qcac012]

Socioeconomic variations determine the clinical presentation, aetiology, and outcome of infective endocarditis: a prospective cohort study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry

C. Sparano;
2022

Abstract

Aims Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socioeconomic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multicentre registry.Methods and results The EurObservational Programme (EORP) of the European Society of Cardiology EURO-ENDO (European Infective Endocarditis) registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in three groups, according to World Bank economic stratification [group 1: high income (75.6%); group 2: upper-middle income (15.4%); group 3: lower-middle income (9.1%)]. Group 3 patients were younger [median age (interquartile range, IQR): group 1, 66 (53-75) years; group 2, 57 (41-68) years; group 3, 33 (26-43) years; P < 0.001] with a higher frequency of smokers, intravenous drug use, and human immunodeficiency virus infection (all P < 0.001) and presented later [median (IQR) days since symptom onset: group 1, 12 (3-35); group 2, 19 (6-54); group 3, 31 (12-62); P < 0.001] with a higher likelihood of developing congestive heart failure (13.6%, 11.1%, and 22.6%, respectively; P < 0.001) and persistent fever (9.8%, 14.2%, and 27.9%, respectively; P < 0.001). Among 2157 (69.3%) patients with theoretical indication for cardiac surgery, surgery was performed less frequently in group 3 patients (75.5%, 76.8%, and 51.3%, respectively; P < 0.001), who also demonstrated the highest mortality (15.0%, 23.0%, and 23.7%, respectively; P < 0.001).Conclusion Socioeconomic factors influence the clinical profile of patients presenting with IE across the world. Despite younger age, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and lower use of surgery.
2022
9
85
96
Sengupta, Shantanu P; Prendergast, Bernard; Laroche, Cécile; Furnaz, Shumaila; Ronderos, Ricardo; Almaghraby, Abdallah; Asch, Federico M; Blechova, Ka...espandi
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