A recent study published in the Journal of the American Heart Association reveals a concerning uptick in the incidence of infective endocarditis (IE) among Japan’s older population. Moreover, this increase corresponds with a surge in the in-hospital mortality rate. The study primarily aimed to assess the temporal shifts in clinical characteristics associated with IE and its in-hospital adverse outcomes.
The researchers assembled a retrospective observational study utilizing the national Japanese administrative, case-mix Diagnostic Procedure Combination (DPC) database along with ICD-10 codes ranging from April 2016 to March 2021. The intent was to distinguish adult patients aged 20 years or beyond, afflicted with IE. From this methodology, investigators pinpointed a total of 17,407 IE patients in 963 hospitals during the study period.
Additionally, core comorbidities were highlighted, including valvular heart disease (42.3%), hypertension (31.2%), atrial fibrillation (20.0%), and diabetes (19.0%). Furthermore, it was observed that IE incidence escalated from 2016 to 2021 (2.02 per 100,000 to 2.59 per 100,000 population). Simultaneously, median age rose from 70 to 73 years, the proportion of patients aged over 81 years increased significantly, and in-hospital mortality rate also rose significantly.
Within the study duration, there was a noted increase in the prevalence of atrial fibrillation. The in-hospital mortality rate surge was independently associated with variables like sepsis, renal failure, cerebrovascular complications, heart failure, and increased age. Conversely, cardiac surgery and a more extensive number of total cardiac surgeries were predictive of a lower in-hospital mortality rate. There was no conspicuous change over time in the median length of hospital stays (38 days).
About 61.2% of discharged IE patients were sent home, while 34.9% moved to another hospital. Despite the comprehensive analysis, the study is bound by limitations, including its retrospective observational design, lack of detailed clinical data, inability to evaluate long-term mortality rates, and a primarily Japanese focus limiting the generalizability of results.
In conclusion, the findings underline an worrying rise in IE cases over time in Japan, coupled with an ageing patient demographic and an escalating in-hospital mortality rate. The data advocates for further efforts in tackling this rising disease burden. However, encouragingly, patients undergoing cardiac surgery, particularly those with a higher number of operations, showed a lower in-hospital mortality rate.