AIMS: Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socioeconomic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multicentre registry. METHODS AND RESULTS: The EurObservational Programme (EORP) of the European Society of Cardiology EURO-ENDO (European Infective Endocarditis) registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in three groups, according to World Bank economic stratification [group 1: high income (75.6%); group 2: upper-middle income (15.4%); group 3: lower-middle income (9.1%)]. Group 3 patients were younger [median age (interquartile range, IQR): group 1, 66 (53-75) years; group 2, 57 (41-68) years; group 3, 33 (26-43) years; P < 0.001] with a higher frequency of smokers, intravenous drug use, and human immunodeficiency virus infection (all P < 0.001) and presented later [median (IQR) days since symptom onset: group 1, 12 (3-35); group 2, 19 (6-54); group 3, 31 (12-62); P < 0.001] with a higher likelihood of developing congestive heart failure (13.6%, 11.1%, and 22.6%, respectively; P < 0.001) and persistent fever (9.8%, 14.2%, and 27.9%, respectively; P < 0.001). Among 2157 (69.3%) patients with theoretical indication for cardiac surgery, surgery was performed less frequently in group 3 patients (75.5%, 76.8%, and 51.3%, respectively; P < 0.001), who also demonstrated the highest mortality (15.0%, 23.0%, and 23.7%, respectively; P < 0.001). CONCLUSION: Socioeconomic factors influence the clinical profile of patients presenting with IE across the world. Despite younger age, patients from the poorest countries presented with more frequent complications and higher mortality associated with delayed diagnosis and lower use of surgery.

Aix Marseille Univ IRD APHM MEPHI IHU Méditerranée Infection Marseille France

Cardiac Imaging Department ICBA Instituto Cardiovascular Buenos Aires Argentina

Cardiology and Angiology Department University of Alexandria Alexandria Egypt

Cardiology Department CHU Timone Marseille France

Cardiovascular Core Labs MedStar Health Research Institute Washington DC USA

Cardiovascular Division Department of Medicine 2 Kansai Medical University Osaka Japan

Department of Cardiac Surgery Hospital Na Homolce Prague Czech Republic

Department of Cardiology Centre Hospitalier Territorial Gaston Bourret Médipôle Dumbéa New Caledonia France

Department of Cardiology Dubai Hospital Dubai UAE

Department of Cardiology King's College Hospital London UK

Department of Cardiology Sengupta Hospital and Research Institute Ravinagar Square Ravinagar Nagpur 440033 India

Department of Cardiology St Thomas' Hospital London UK

Department of Clinical Microbiology and Infectious Diseases Hadassah Hebrew University Medical Center Jerusalem Israel

Department of Research National Institute of Cardiovascular Diseases Karachi Pakistan

EurObservational Programme European Society of Cardiology Sophia Antipolis France

GIGA Cardiovascular Sciences Department of Cardiology and Cardiovascular Surgery University of Liège Hospital CHU SartTilman Liège Belgium

Gruppo Villa Maria Care and Research Maria Cecilia Hospital Cotignola and Anthea Hospital Bari Italy

Hospital Israelita Albert Einstein and Incor Heart Institute São Paulo University Medical Schiool São Paulo Brazil

Jewish General Hospital Montreal Canada

King Saud bin Abadulaziz University for Health Specialities Ministry of National Guard Riyadh Saudi Arabia

National Cerebral and Cardiovascular Center 6 1 Kishibe Shinmachi Suita Osaka Japan

References provided by Crossref.org

Cardiac device-related infective endocarditis need for lead extraction whatever the device according to the ESC EORP EURO-ENDO registry