Long-term Outcome of Infective Endocarditis in Non-Intravenous Drug Users

OBJECTIVE To describe postdischarge survival rates and late complications in non-intravenous drug users (non-IVDUs) after treatment of infective endocarditis (IE). PATIENTS AND METHODS This prospective study consists of consecutive cases of IE in non-IVDUs seen between January 1, 1994, and August 31, 2005. Patient treatment (ie, pharmaceutical and/or surgical) and cardiac valve involved in infection (ie, aortic and/or mitral; whether valve was native or prosthetic) were recorded. Patient follow-up, to March 31, 2007, occurred at 1, 2, 3, and 4 years. Complications, survival, and mortality were statistically analyzed. RESULTS During the study period, 230 episodes of IE in 222 non-IVDUs were attended. A total of 143 patients (64%) were discharged from the hospital. Mean ± SD age of discharged patients was 61±17 years. Survival at 1-, 2-, 3-, and 4-year follow-up was 88%, 82%, 76%, and 67%, respectively. Survival was similar for patients with native-valve IE and those with prosthetic-valve IE. The only independent predictors of long-term mortality after discharge were age (hazard ratio, 1.04; 95% confidence interval, 1.01-1.06; P =.002) and comorbidity (Charlson index HR, 1.33; 95% confidence interval, 1.18-1.49; P CONCLUSION Among non-IVDUs discharged after treatment for IE, 4-year mortality was 33%, and mortality increased with age and comorbidity. Recurrent endocarditis was uncommon in properly treated patients. Survival was similar for patients with native-valve IE and those with prosthetic-valve IE. Survival was also similar for patients who underwent surgery during hospitalization and those who did not.