The clinical value of the endocarditis team - insights from before and after guidelines implementation strategy

Background- Despite improvements in the diagnosis and management of infective endocarditis (IE), it is associated with poor survival. Following 2015 guidelines recommendation, the Endocarditis Team (ET) was established in our medical center implementing a multidisciplinary decision and therapeutic approach.

The aim of this study was to evaluate the impact of a multidisciplinary ET on the outcome of patients with acute IE according to medical or surgical treatment strategies.

Methods and Results- We conducted an observational before-and after study of 221 consecutive patients with definite IE, who were treated at our tertiary reference center, between 2013 and 2019. The study cohort was divided into two periods: before the establishment of the ET (n=92), and after the establishment of the ET (n=129). The role of the ET included ad-hoc multidisciplinary team consultation meetings to confirm diagnosis, recommend the type and duration of antibiotic therapy and decide for conservative management vs surgery and timing according to ESC guidelines. The patient demographics and predisposing conditions were comparable between the two groups, except prosthetic valves which was more prevalent in the ET group (20.3% vs 40.6% p=0.05) . The utility of FDG PET CT and Cardiac CT was significantly higher with the ET (35.9% vs 12% and 40.6% vs 6.5% respectively, p<0.001). The incidence of valve replacement surgery was equal in both groups (32.2% vs 34.6%, p=0.71) as well as hospital duration time (26.9±21.7 vs 23.0±14.2 days, p=0.17). The short term outcome (up to 1 year) was similar in both groups. However, at 3 years mortality was significantly lower for the ET group (35.2% vs 50.7%, p=0.03).

Conclusions: A multidisciplinary team approach was associated with improved long term survival. Our results support the ESC guidelines recommendation to use a multidisciplinary team approach for IE patients management.