Is the clinical spectrum and prognosis of native valve infective endocarditis in non-addicts changing?

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Abstract
One hundred and ninety-four episodes of endocarditis on native valves in non-addict patients were diagnosed from 1975 to 1992 and were divided into groups A (78 patients, 1975–1983) and B (116 patients 1984–1992). Both groups had the same gender distribution, similar valvular involvement and microbiological characteristics. In group B patients, median age was older (46 vs 54 years, P=0.0002), the number of patients without previous heart disease was higher (46% vs 22%, P=0.02) and the median time of symptoms before diagnosis was shorter (30 vs 50 days, P=0.038). Both groups had similar incidence of heart failure (32% vs 36%), surgical treatment (30% vs 33%) and embolic episodes (26% vs 34%). Surgical mortality decreased from 43% to 18% (P=0.03). Overall mortality decreased non-significantly from 19% in group A to 12% in group B. Predictors of death in group A were heart failure (odds ratio 9.6, 95% confidence interval 3.36) and surgical treatment (odds ratio 5, 95% confidence interval 1–3–19). Predictors of death in group B were age (odds ratio 498, 95% confidence interval 1–4–19), female sex (odds ratio 5.3, 95% confidence interval 1–3–20), staphylococcal infection (odds ratio 49, 95% confidence interval 1–1–22) and heart failure (odds ratio 5.2, 95% confidence interval 1–3–20). Although in recent years infective endocarditis occurs in older patients and is more common in patients with previously unknown heart disease a substantial change in major clinical and prognostic variables is not apparent in our population. Overall in-hospital mortality has decreased from 19%> to 12% mainly due to better surgical results.

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