Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.
- heart block
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Contributors SMJ and AK are credited with substantial contribution to the design of the work, acquisition and interpretation of data, drafting the manuscript, revision for important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work. MA is credited with substantial contribution to interpretation of data, literature review of all sections discussed, drafting the manuscript, final approval of the version published, and agreement on accountability for all aspects of the work. BB is credited with substantial contribution to acquisition, analysis, and interpretation of data, revision for critically important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work. JS, FW, MSZ, MA, and MDK are credited with interpretation of data, literature review of all sections, revision for important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work. RS, MA, HWK, MK, and MZK are credited with interpretation of data, literature review specifically for the discussion section, revision of the work for critically important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Our institution does not require ethical approval for NIS database studies.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. The Healthcare Cost and Utilization Project (HCUP) databases are limited data sets. HCUP databases conform to the definition of a limited data set. A limited data set is healthcare data in which 16 direct identifiers, specified in the Privacy Rule, have been removed. Please see the following web link: https://www.hcup-us.ahrq.gov/DUA/dua_508/DUA508version.jsp.
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