Abstract
BACKGROUND: Current guidelines recommend discussing patients with infective endocarditis in an endocarditis team (ET). The benefits of an ET have been established, but not the evolution over time. OBJECTIVES: The objective of the study was to investigate changes in management and outcomes in infective endocarditis over time. METHODS: All patients discussed by our ET since 2016 were prospectively included and divided into 3 cohorts. Trends over time for the number of discussions, diagnostics, ET recommendations, treatment, and outcomes were assessed using Poisson, logistic, and Cox regression, respectively, adjusted for potential case mix. RESULTS: The total cohort included 1,042 patients, with 223, 364, and 455 patients in cohorts 1 (2016-2018), 2 (2019-2021), and 3 (2022-2024), respectively. The percentage of patients with a rediscussion increased with 18.2% (P < 0.001), and the number of discussions per patient increased with 3% per diagnosis-year (P = 0.006). The percentage of patients with positive blood cultures decreased with 17.5% (P < 0.001), whereas cardiac computed tomography (CT) and positron emission tomography (PET) CT usage increased with 3.1% (P = 0.028) and 12.5% (P < 0.001), respectively. Advice for additional diagnostic tests decreased by 11.6% (P < 0.001), and treatment change decreased by 18.3% (P < 0.001). Reclassification of the initial diagnosis increased with 8.3% (P = 0.045). Relapse (P = 0.82) and reinfection rates did not change (P = 0.98). One-year survival was approximately 80% and remained stable (P = 0.62). CONCLUSIONS: There were more referrals and rediscussions, but less need for additional advice, reflecting increased familiarity with and a learning effect of the ET. CT and PET-CT were used more often. Mortality did not change over time and remained high.