Hospital Indicators for the Management of Native and Prosthetic Valve Infective Endocarditis Across Brazilian Regions From 2015 to 2024

OBJECTIVE: This study aimed to analyze regional distributions and temporal trends in approved Hospital Admission Authorizations (AIHs), in-hospital deaths, proportions of admissions resulting in in-hospital death, and length of hospital stay associated with hospital care for native-valve and prosthetic-valve infective endocarditis in Brazil from 2015 to 2024. METHODS: This retrospective ecological time-series study used aggregated data from the Brazilian Unified Health System Hospital Information System, accessed through DATASUS, for 2015-2024. Approved AIHs linked to selected procedure codes for native-valve and prosthetic-valve infective endocarditis treatment were analyzed across Brazil's five regions, classified by hospital location. Descriptive measures included frequencies, deaths per 100 approved AIHs, mean hospital stay, and dispersion. Annual AIH and recorded in-hospital death rates per 100,000 population were calculated using year-specific regional population estimates. Trends in these rates were assessed using the Joinpoint Regression Program (version 6.0.1; U.S. National Cancer Institute, Bethesda, MD), estimating annual percentage changes (APCs) and average APCs with 95% confidence intervals from 10 annual observations per series. Statistical significance was set at α = 0.05. RESULTS: Native-valve treatment records comprised 13,920 approved AIHs and 1,966 in-hospital deaths (14.1 deaths per 100 AIHs), with authorizations concentrated in the Southeast and Northeast. AIH rates per 100,000 population declined significantly in the Northeast during 2015-2019 and increased in the Southeast during 2020-2024. Recorded in-hospital death rates per 100,000 population increased significantly in the Southeast and South. Prosthetic-valve treatment records comprised 6,610 approved AIHs and 1,115 in-hospital deaths (16.9 deaths per 100 AIHs). AIH rates fluctuated in the North and increased significantly in the Southeast during 2021-2024. No statistically significant regional trends were identified in recorded in-hospital death rates for this treatment category. CONCLUSION: Hospital records linked to the selected infective endocarditis treatment procedure codes showed heterogeneous regional trends and a higher cumulative number of in-hospital deaths per 100 approved AIHs for prosthetic-valve treatment. These findings characterize recorded hospital utilization within SUS and may inform regional service monitoring and planning.