Infective endocarditis lethal in elderly

Elderly patients with infective endocarditis (IE) have unique clinical characteristics and are twice as likely to die from IE as their younger counterparts, data from a large prospective, multicentre study shows. The elderly population has seen a rapid increase in the incidence of IE in recent times. It is not clear what has influenced this increase in incidence as studies to date have provided conflicting data. Indeed, based on the unique characteristics IE displays in the elderly, it is unclear if it is distinct from the disease in younger people. Durante-Mangoni et al. sought to clarify this issue. They conducted a large, multicentre, prospective study to evaluate the impact of advanced patient age on the clinical features and outcomes of IE. They compared 2759 consecutive patients with IE aged 65 years with 1703 patients aged less than 65 years to assess variables that affect epidemiology, aetiology, clinical presentation, treatment and outcome of IE. Variables included demographic data, risk factors, predisposing conditions, possible sources of bacteraemia, causative pathogens, medications taken, clinical features, presenting signs and symptoms, echocardiographic findings, treatment, complications as well as course and outcome of IE. They found that IE in elderly patients does have distinctive features compared with their younger counterparts with IE. Data revealed that an invasive procedure or hospitalisation often occurred prior to the onset of IE in the elderly. Staphylococcus aureas was identified as the most common causative pathogen in both age groups; however, methicillin resistance, enterococci and S. bovis were considerably more prevalent among elderly patients. Despite experiencing lower rates of complications such as strokes and peripheral emboli, the in-hospital death rate for elderly patients was twice that of their younger counterparts. The major predisposing conditions were identified as diabetes, genitourinary cancer gastrointestinal cancer. However, the researchers cautioned that the higher prevalence of diabetes in elderly IE patients could influence the death rate because diabetes was found to be an independent predictor of mortality in IE. Multivariate analyses identified age older than 65 years as a strong independent risk factor for in-hospital death (odds ratio 2.04; p<0.001) and an independent predictor of fewer surgical interventions (p<0.001) among patients with IE. “The clinical characteristics of IE in elderly patients differ substantially in terms of the pattern of cardiac involvement, the causative microorganisms, and the type and frequency of complications,” they explained. They concluded that IE is a particularly lethal condition among elderly patients, and that age appears to be a significant factor in determining the unique nature of IE among the elderly. Reference Durante-Mangoni, E. Bradley, S. 2008, ‘Current features of infective endocarditis in elderly patients’ Archives of Internal Medicine; 168: 2095—2103....