Infective Endocarditis in Octogenarians—A Multicenter Analysis

In this study, the authors investigate the clinical presentation, microbiological profile, and outcomes of infective endocarditis in octogenarians. This multicenter retrospective analysis, utilizing data from the CAMPAIGN Registry, includes 4,917 consecutive patients suffering from infective endocarditis. The authors specifically analyzed data on octogenarians undergoing surgery due to infective endocarditis, with primary outcomes measuring 30-day mortality and five-year survival. Out of the total cohort, 292 patients (5.9 percent) were octogenarians, with a median age of 82 years (range 81-84 years), compared to a median age of 65 years (range 54-73 years) in the nonoctogenarian cohort. The median EuroSCORE II was 16.5 (9.5-40.4) in the octogenarian group and 9.7 (4.4-21.5) in the nonoctogenarian group (p < 0.001). There was a higher number of males in the nonoctogenarian group (p < 0.001). Prosthetic valve endocarditis (p < 0.001) and pacemaker endocarditis (p < 0.001) were higher in the octogenarian group. Streptococcal infections were more frequent in the octogenarians (p = 0.033), whereas a significantly higher number of nonoctogenarians suffered from blood culture-negative infective endocarditis (p = 0.002). The rate of postoperative adverse cerebrovascular events and postoperative morbidities was comparable between the groups. The 30-day mortality was higher in the octogenarian group (p < 0.001). Survival rates at one year and five years were 48 percent and 39 percent, respectively, in the octogenarian group (p < 0.001). The authors conclude that infective endocarditis in the elderly is associated with a higher risk and may present with a different clinical profile. Although advanced age does play a role in the outcomes of surgery for infective endocarditis, it alone should not be the sole factor to rule out surgery in this cohort.