ENDOCARDITIS TEAM? DESIGNING AN ORIGINAL AND TAILORED CLINICAL PATHWAY

Background and Aim: Incidence of infective endocarditis (IE) is worryingly increasing. Clinical care of IE is often fragmented resulting in delayed diagnosis and suboptimal management. According to recent guidelines, in 2023 we created the Endocarditis Team (ET), providing the most appropriate diagnostic tests and treatment options through a dedicated clinical pathway (CP). In this study we compare clinical and management outcomes of patients treated before and after the CP. Methods: We prospectively collected data from surgically treated patients, at our institution, after the CP implementation (post-CP group) and compared them with data from the previous 3 years (pre- CP group). We analyzed baseline characteristics such as clinical presentation, disease complexity, in-hospital mortality and management outcomes such as ICU stay and post- operative and total in-hospital length of stay. Results: Fifty-six patients underwent surgery for IE during the Post-CP group (2023-2024), compared to 82 patients in the Pre-CP group (2020-2022). Clinical presentation was similar in the two groups even though patients in the Post-CP group had higher numbers of pseudoaneurysms, abscesses and redo procedures. STS-PROMM was higher in the Post-CP group (33.4 ± 7.5 vs 29.3 ± 8.7, p<0.01 ). No difference for in-hospital mortality was found (7.3% vs 8.9%). Length of ICU (4 vs 6 days) and post-operative in-hospital stay (30.5 vs 32 days) increased in the post-CP group. Total in-hospital stay showed a two-day reduction in the post-CP group (43 vs 41 days). Conclusions: Although some controversies still exist, we believe that our ET had a positive impact on healthcare of patients with IE.