Management and outcomes of infective endocarditis in a community hospital and its cardiac surgery referral centre

Despite advances in diagnosis and management, infective endocarditis (IE) remains a life-threatening condition with a high mortality rate. Most data originate from cardiac surgery centres, limiting our understanding of outcomes in community settings. Our aim was to compare the management and clinical outcomes of IE in a community hospital (HSJD) and its surgical referral centre (HSP) and to identify predictors of mortality. We conducted a retrospective cohort study (2018-2024) including all adult patients meeting the diagnostic criteria for IE. Mortality rates were compared across centres. Predictors of mortality were identified using Cox proportional hazards models. A total of 137 patients were included: 53 at HSJD and 84 at HSP. Definite IE was diagnosed more frequently at HSP (83.3% vs. 54.7%), and multidisciplinary endocarditis team discussions and use of advanced imaging were also more common. Thirty-day mortality did not differ significantly between centres (17.0% vs. 11.9%), nor during longer follow-up. Independent predictors of 30-day mortality included a higher Charlson Comorbidity Index, Staphylococcus aureus infection, and sepsis-related complications. Surgery was performed in 30% of patients diagnosed at HSJD and 43% of HSP patients. Among patients with a surgical indication, undergoing surgery was associated with a reduced risk of death across all follow-up periods. Patients who were not transferred to HSP were older, had higher comorbidity scores, and had a twofold increased risk of death compared with transferred patients. Mortality did not differ significantly between centres. These findings suggest that decentralised management of IE may be feasible while highlighting the importance of multidisciplinary collaboration, coordinated referral pathways, and access to advanced diagnostic resources.