Infective Endocarditis in the Elderly Patients

Na, Sang Hoon; Kim, Cheol Ho; Oh, Myung Don; Cho, Young Seok

Abstract

BACKGROUND: Improved diagnostic and therapeutic strategies for infective for infective endocarditis such as proposed diagnostic criteria, Duke criteria and echocardiography resulted to increased life-spans of patients.
METHODS
Retrospective analysis of medical records including medical history, laboratory data such as echocardiographic data and blood culture, and clinical outcomes was done for 106 patients with clinical diagnosis of infective endocarditis at Seoul National University Hospital from January 1990 to May 2000. Then we analysed differences of clinical features between elderly patients aged > or =60-years and the adult patients aged <60-years with infective endocarditis.
RESULTS
The elderly patients >or=60-year are cases of 14%(15/106) and the mean ages are 67+/-8 years in elderly patient, 38+/-12 years in the adults patients respectively. Valvular heart disease was the most common predisposing heart disease with 9 cases(40%) followed by prosthetic valve endocarditis 2 cases (13%) in elderly patients, and there was no significant difference of frequencies with adult patients (valvular heart diseases, 33%; prosthetic valvular heart diseases, 25%). Although culture positive rates were not different with two groups: 47%(7/15) in elderly patients and 45%(41/91) in adult patients, the most common pathogen was staphylococcal species in elderly patients(27%, 4/15) but streptococcus species, in the adult patients(25%, 26/106, p<0.05). The frequencies of embolic complication were not different between two groups(20%, 3/15 vs 22%, 20/91: Elderly vs adult, respectively), but congestive heart failure was more developed in elderly patients, 33%(5/15) than in adult patients, 10%(9/91, p<0.05). Surgical intervention was more required in the elderly(47%, 7/15) than in adult patients(22%, 20/91, p<0.05). Out of 106 patients, 11 died and the overall mortality was 10.4%(11/106). In-hospital death was more common in the elderly than in adult patients: 4 cases(27%) vs 8%(7/91), p<0.05. Determinants of in-hospital death were patients with 60 years of age and older, Staphylococcus aureus endocarditis, and the presence of congestive heart failure(p<0.05) in univariate analysis.
CONCLUSION
Infective endocarditis in elderly patients(age> or =60) had more poor outcomes than adult patients(age<60) such as the development of congestive heart failure, the need of surgical intervention, and the high mortality rate.