Evolution of the incidence, mortality, and cost of infective endocarditis in Spain between 1997 and 2014

Abstract

Introduction: There is uncertainty about the magnitude of infectious endocarditis (IE), with a wide range in reported incidence (3.5 to 10 cases per 100,000 persons-year), and mortality (29 to 40%).1,2,3,4,5 Discrepancies may be due to clinical and methodological differences between studies. The aging of the population, more aggressive interventions, and the increase of poverty are potentials and are possible epidemiological factors affecting IE over the last decades, particularly in Europe. The Spanish public health system is free and covers nearly all population (46.5 million inhabitants in 2017). Our aim was to assess evolution of incidence, mortality, length of hospital stay, and costs related to IE between 1997 and 2014. Methods: We used the Basic Minimum Data Set (BMDS) of the National Surveillance System for Hospital Data in Spain (Spanish Ministry of Health) to obtain retrospective data in all admissions for IE with hospital discharge from January 1, 1997 to December 31, 2014. Diagnoses and comorbidities were available in ICD-9 CM codes. IE was considered (421, acute and subacute endocarditis) regardless of whether it was a primary or secondary diagnosis. An anonymized dataset with demographic data (sex, age), comorbidities, associated organ dysfunction(s), Charlson’s index, and mortality information was generated. Results: Overall, 34,399 patients were diagnosed with IE. The adjusted IE incidence (events per 100,000 persons) was 4.3%, ranging from 3.2% in 1997 to 5.6% in 2014. Age-adjusted incidence was higher in the 75–79 age group. Higher rates were observed in males than in females (67 v. 33%).