Delays in Diagnosing Infective Endocarditis—Analysis of an Endocarditis Network

Background: A timely diagnosis of infective endocarditis (IE) is essential for effective treatment and avoidance of systemic sequelae of the disease. In this study we analyze presenting symptoms, outcomes of patients, and the components of our endocarditis network.

Methods: Between January 2012 and December 2021, 812 consecutive patients were admitted to our center for IE. Records on exact diagnosis dates could be collected in 707 patients (87.1%). Patients were divided into two groups based on the time to diagnosis, i.e., up to 7 days (509 [72%]) and above 7 days (198 [28%]). Details on the individual hospitals were collected from the German hospital database. Data are presented as medians and 25th–75th percentiles, or absolute numbers and percentages.

Results: Patients diagnosed later underwent surgery less frequently (366 [71.9] vs. 102 [51.5], p < 0.001). The EuroSCORE II was higher in patients who were diagnosed later (4.6 [2.3–10.0] vs. 7.4 [3.6–16.8], p = 0.001). The median time to diagnosis was shorter in university hospitals as compared with non-teaching hospitals (p = 0.008). Time to diagnosis was shortest in patients admitted to cardiology and cardiac surgery departments and longest in patients admitted to surgery and oncology departments (p < 0.001). Patients fulfilling Duke criteria (p = 0.023), history of drug use (p = 0.037), septic embolisms (p < 0.001), septic cerebral embolisms (p = 0.044), and streptococcal infections (p < 0.001) were diagnosed earlier. Patients with a prolonged time to diagnosis had a significantly higher intra-hospital mortality (68 [13.4%] vs. 40 [20.2%], p = 0.027). Patients were referred to our center from 93 other hospitals. Among referral hospitals, the most commonly available diagnostic tool after echocardiography was computed tomography (75.3%). Specialized diagnostic methods such as MRI and PET-CT were available in 51.6 and 22.6% of the hospitals respectively. Survival at 1 year (76% vs. 62%) and 5 years (71% vs. 59%) was significantly higher in the patients diagnosed under 7 days (p < 0.001).

Conclusion: In our study we see that more than one in four patients have a prolonged time to diagnosis and this may result in higher rates of mortality. The successful treatment of IE requires physician awareness and vigilance and adequate diagnostic tools to diagnose patients early and initiate treatment.

Publication History

Article published online:
11 February 2025