Elsevier

American Heart Journal

Volume 259, May 2023, Pages 9-20
American Heart Journal

Clinical Investigations
Long-term incidence of infective endocarditis among patients with congenital heart disease

https://doi.org/10.1016/j.ahj.2023.01.012Get rights and content

Background

Patients with congenital heart disease (CHD) are at lifelong high risk of infective endocarditis (IE). The risk of IE presumably differs among different CHD, but little knowledge exists on the area.

Methods

In this observational cohort study, all CHD-patients born in 1977 to 2018 were identified using Danish nationwide registries and followed from the date of birth until first-time IE, emigration, death, or end of study (December 31, 2018). The comparative risk of IE among CHD-patients vs age- and sex-matched controls from the background population was assessed. The risk of IE was stratified according to the type of CHD and factors associated with IE including sex and relevant time-varying coefficients (ie, cyanosis, cardiac prostheses, diabetes mellitus, chronic kidney disease, and cardiac implantable electronic devices) were examined using Cox-regression analysis.

Results

A total of 23,464 CHD-patients (50.0% men) were identified and matched with 93,856 controls. During a median follow-up of 17.7 years, 217(0.9%) CHD-patients and 4(0.0%) controls developed IE, corresponding to incidence rates of 5.2(95%CI 4.6-6.0) and 0.02(95%CI 0.01-0.1) per 10,000 person-years, respectively. The incidence of IE was greatest among patients with tetralogy of fallot, malformations of the heart chambers (including transposition of the great arteries, univentricular heart, and truncus arteriosus), atrioventricular septal defects, and heart valve defects. Factors associated with IE among CHD-patients included male sex, cyanosis, cardiac prostheses, chronic kidney disease, and cardiac implantable electronic devices.

Conclusions

CHD-patients have a substantially higher associated incidence of IE than the background population. With the increasing longevity of these patients, relevant guidelines concerning preventive measures are important.

Section snippets

Data sources

All Danish residents are assigned a unique and permanent civil registration number allowing accurate linkage of nationwide administrative registries at an individual level. For this study, data from the following two Danish administrative registries were obtained: (1) The Danish National Patient Registry, which holds information on all hospital admissions and outpatient contacts according to the International Classification of Diseases (ICD) 8th and 10th revision and surgical procedures

Baseline characteristics

In the period from January 1, 1977, to December 31, 2018, 23,464 patients (50% men) were born and diagnosed with CHD in Denmark at one of the 4 university hospitals (Figure 1). These patients were matched with 93,856 controls from the background population. In total, 1,144 (4.9%) CHD-patients were born in the 70s, 4,159 (17.7%) in the 80s, 6,318 (26.9%) in the 90s, 7,063 (30.1%) in the 00s, and 4,780 (20.4%) in the 10s. The median age at time of CHD diagnosis was 1.0 years (25th-75th percentile

Discussion

In this nationwide study, we examined the long-term incidence of IE in a birth cohort of Danish residents diagnosed with CHD during a 42-year observation period from 1977 to 2018. The study yielded the following major four findings: First, the burden of IE among patients with CHD was substantial with an incidence rate of 5.2 per 10,000 PY corresponding to a more than 50 times higher rate of IE than that of age- and sex-matched controls from the background population. Second, the CHDs with the

Conclusion

The long-term incidence of IE among patients with CHD is substantial and significantly higher compared with the background population. Patients with CHD in high risk of IE is a heterogenous group including patients with cyanotic heart defects, but also atrioventricular septal defects, and heart valve defects, meanwhile factors associated with an increased risk of IE among patients with CHD include male sex, cardiac prosthesis, chronic kidney disease, and presence of cardiac implantable

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

EHB: None declared, JHB: None declared, LØ: None declared, JKP: None declared, CTP: Grant for randomized study from Bayer and grant for epidemiological study from Novo Nordisk, LK: Serves as a consultant for Boehringer Ingelheim, and has received other support from AstraZeneca, Novartis, and Novo Nordisk, ELF: None declared

Acknowledgments

None

References (26)

  • L Østergaard et al.

    Incidence of infective endocarditis among patients considered at high risk

    Eur Heart J

    (2018)
  • L Østergaard et al.

    Incidence of infective endocarditis in patients considered at moderate risk

    Eur Heart J

    (2019)
  • E Lynge et al.

    The Danish National Patient Register

    Scand J Public Heal

    (2011)
  • Cited by (0)

    View full text