Abstract 4124769: Temporal Changes in Clinical Characteristics and Oucomes of Infective Endcarditis: A Report from JROAD-DPC Study

Background: Despite advances in medical science and patient care, infective endocarditis (IE) is still a serious and life-threatening disease. Considering the recent shifts in predisposing clinical backgrounds of cardiovascular disease, such as an aging population and increased usage of prosthetic valves and cardiovascular implantable electronic devices, ongoing updates to patient characteristics and outcomes of infective endocarditis (IE) are essential for providing precision diagnoses and effective treatments. Objective: To examine temporal trends in the clinical characteristics and in-hospital occurrence of adverse outcomes of IE. Methods: Observational study of using a nationwide Japanese administrative database (JROAD-DPC), that is operated by the Japanese Circulation Society. IE was identified based on the code of the International Classification of Diseases, Tenth Revision. The study outcomes were in-hospital mortality and IE-compatible complications (heart failure, cerebrovascular episodes, renal failure, and sepsis). Results: Between the years 2016 and 2021, a total of 17,407 IE patients (37.8% female; median age 72 (IQR, 59-81) years) were identified in JROAD-DPC database. The incidence of IE increased from 2.02 per 100,000 population (2,534 cases) in 2016 to 2.59 (3,183 cases) in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. Notably, the proportion of patients older than 80 years rose from 25.4% to 30.8%. The in-hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (OR, 1.34; 95% CI, 1.29 to 1.40; <.001), heart failure (OR, 1.37; 95% CI, 1.18 to 1.59; P<.001), cerebrovascular complications (OR, 1.78; 95% CI, 1.59 to 1.99; P<.001), renal failure (OR, 2.36; 95% CI, 2.06 to 2.70; P<.001), and sepsis (OR, 2.79; 95% CI, 2.48 to 3.13; P<.001), were independently associated with increased in-hospital mortality. In contrast, cardiac surgery (OR, 0.47; 95% CI, 0.41 to 0.55; P<.001), and a higher number of total cardiac surgeries (OR, 0.77; 95% CI, 0.65 to 0.92; P<.004) independently predicted a lower in-hospital mortality. Conclusions: The characterization and comprehensive analysis of IE in Japan provide valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.