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Am Fam Physician. 1998;58(3):772-774

Previously published studies have suggested that the clinical presentation of endocarditis tends to be more subtle in elderly patients than in younger patients. Older patients reportedly have fewer symptoms, including fever, and this results in delayed diagnosis. This delay may cause a higher complication rate among the elderly. Gagliardi and colleagues conducted a retrospective study of patients who were hospitalized with endocarditis to compare clinical features and outcomes in elderly and younger patients with native valve endocarditis.

A total of 108 patients who had been hospitalized with infective endocarditis between 1986 and 1997 were selected for the study. The patients were divided into two groups: those older than 65 years and those 30 to 59 years of age. Researchers excluded patients between 60 and 64 years of age in order to capture distinct age-related differences in the two groups. They also excluded intravenous drug users and patients with prosthetic valves, as these patients tend to have unique features that affect their outcome. Sixty-four patients were assigned to the younger group, and 44 were assigned to the elderly group. Data collected included the presence of comorbid illnesses; fever higher than 38°C (104°F) on two or more occasions; the specific organisms isolated from at least two or more blood cultures; the degree of valvular involvement based on echocardiographic findings; new onset of renal failure (creatinine level higher than 2 mg per dL [180 μmol per L]); new or worsening heart failure; and the occurrence of vascular phenomena or emboli. Additional data included myocardial infarction, the need for cardiac surgery, length of hospitalization and death during hospitalization.

There were no significant differences in the type of valvular involvement or the distribution of organisms, with streptococcal species being most prevalent. There were also no significant differences noted in the frequency of fever, arrhythmias, renal failure, embolic events and valvular surgery. Mortality rates were higher for the elderly group, but not significantly so. Ten (16 percent) of the younger patients died, as did 12 (27 percent) of the older patients. There were also higher rates of myocardial infarction and altered mental status among the elderly patients, but these differences were not statistically significant. The only major difference between the two groups was duration of hospital stay, which averaged 42 days in the elderly group and 30 days in the younger group.

The authors conclude that age does not appear to be a predictor of mortality in patients with native valve endocarditis. Renal failure or cerebral emboli predicted poor outcomes in these patients, regardless of age. The authors believe that early and aggressive management of native valve endocarditis is indicated, regardless of patient age.

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Copyright © 1998 by the American Academy of Family Physicians.

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