Comparison of Infective Endocarditis Management and Outcomes in a Community Hospital and its Cardiac Surgery Referral Centre: A Contemporary Population-Based Cohort Study (2018–2024)

Abstract

<title>Abstract</title> Purpose. 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 centers, 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 reference center (HSP) and to identify mortality predictors. Methods. We conducted a retrospective cohort study (2018–2024) including all adult patients meeting the diagnostic criteria for IE. Mortality rates were compared across centers. Predictors of mortality were identified via Cox proportional hazards models. Results . A total of 137 patients were included: 53 at HSJD and 84 at HSP. Thirty-day mortality did not differ significantly across centers (17.0% vs 11.9%), nor did longer follow-up. Independent predictors of 30-day mortality included a higher Charlson Comorbidity Index, <italic>Staphylococcus aureus</italic> infection, and sepsis-related complications. Surgery was performed in 30% of patients at HSJD and 43% at HSP. 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 twice the risk of death compared with transferred patients. Conclusion. The outcomes for patients with IE diagnosed at a community hospital were comparable to those at a cardiac surgery referral centre. These findings suggest that effective IE management is feasible across different healthcare levels when supported by specialised clinicians and coordinated multidisciplinary management.

Affiliated Institutions

• Althaia ES
• Hospital de Sant Pau ES
• Universitat Autònoma de Barcelona ES

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